Provider Demographics
NPI:1033277421
Name:SPRAGG, PAUL ALEXANDER (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:SPRAGG
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 LINCOLN ST
Mailing Address - Street 2:STE. 702
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2136
Mailing Address - Country:US
Mailing Address - Phone:303-830-7345
Mailing Address - Fax:303-831-0559
Practice Address - Street 1:1120 LINCOLN ST
Practice Address - Street 2:STE. 702
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2136
Practice Address - Country:US
Practice Address - Phone:303-830-7345
Practice Address - Fax:303-831-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1153103T00000X, 103TB0200X, 103TC0700X, 103TF0200X, 103TM1800X
CO344980103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04142121Medicaid
CO07026198Medicaid
COUR 19323OtherDIV VOC REHAB
CO04142121Medicaid
COA1616Medicare ID - Type Unspecified