Provider Demographics
NPI:1003217019
Name:CLINICAL PSYCHOLOGIST PLLC
Entity Type:Organization
Organization Name:CLINICAL PSYCHOLOGIST PLLC
Other - Org Name:PEPE SANTANA, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-272-0565
Mailing Address - Street 1:90 MADISON ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:720-272-0565
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 402
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:720-272-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38358255Medicaid
COCOB4300Medicare PIN