Provider Demographics
NPI:1063633642
Name:ATKINSON, MONTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 11TH ST.
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5101
Mailing Address - Country:US
Mailing Address - Phone:303-444-2245
Mailing Address - Fax:303-545-9803
Practice Address - Street 1:2027 11TH ST.
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5101
Practice Address - Country:US
Practice Address - Phone:303-444-2245
Practice Address - Fax:303-545-9803
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07100514Medicare ID - Type Unspecified