Provider Demographics
NPI:1013186519
Name:PSYCHOTHERAPY SERVICES, PC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SCHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENNIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, CACIII
Authorized Official - Phone:719-447-9800
Mailing Address - Street 1:223 N WAHSATCH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3479
Mailing Address - Country:US
Mailing Address - Phone:719-447-9800
Mailing Address - Fax:719-447-1994
Practice Address - Street 1:223 N WAHSATCH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3479
Practice Address - Country:US
Practice Address - Phone:719-447-9800
Practice Address - Fax:719-447-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO286060Medicaid