Provider Demographics
NPI:1235250754
Name:GISI,, THERESA M (PH D)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:GISI,
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:MISS
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:ZUMBRUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6270 LEHMAN DR
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1469
Mailing Address - Country:US
Mailing Address - Phone:719-641-0222
Mailing Address - Fax:719-623-0008
Practice Address - Street 1:17730 SMUGGLERS RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8517
Practice Address - Country:US
Practice Address - Phone:719-641-0222
Practice Address - Fax:719-623-0008
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist