Provider Demographics
NPI:1114133782
Name:SOFTAS, BASILIA CARMEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BASILIA
Middle Name:CARMEN
Last Name:SOFTAS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:501 20TH ST APCE MCKEE # 248
Mailing Address - Street 2:UNIVERSITY OF NORTHERN COLORADO
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-0001
Mailing Address - Country:US
Mailing Address - Phone:970-351-1631
Mailing Address - Fax:970-351-2625
Practice Address - Street 1:501 20TH ST APCE MCKEE # 248
Practice Address - Street 2:UNIVERSITY OF NORTHERN COLORADO
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-1631
Practice Address - Fax:970-351-2625
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1957103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist