MEDICARE: COGNITIVE CONNECTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891200416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNITIVE CONNECTIONS, LLC

Provider Business Mailing Address
First Line	:	1426 N HANCOCK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2618
Country	:	US
Telephone Number	:	719-650-8559
Fax Number	:	719-632-6458

Provider Business Practice Location Address
First Line	:	1426 N HANCOCK AVE STE 5N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2672
Country	:	US
Telephone Number	:	719-650-8559
Fax Number	:	719-632-6458

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. EMILY INMAN
Credential	:	PSYD
Telephone Number	:	719-650-8559

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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