Provider Demographics
NPI:1033233176
Name:PSYCHOLOGICAL ASSOCIATES OF WESTERN CO. P.C.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF WESTERN CO. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-245-3505
Mailing Address - Street 1:2530 NORTH 8TH STREET
Mailing Address - Street 2:SUITE #204
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8858
Mailing Address - Country:US
Mailing Address - Phone:970-245-3505
Mailing Address - Fax:970-245-1766
Practice Address - Street 1:2530 NORTH 8TH STREET
Practice Address - Street 2:SUITE #204
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8858
Practice Address - Country:US
Practice Address - Phone:970-245-3505
Practice Address - Fax:970-245-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COR18691Medicare UPIN
COC66046Medicare PIN
COR18692Medicare UPIN
COC64326Medicare PIN