Provider Demographics
NPI:1265654693
Name:PIKES PEAK PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:PIKES PEAK PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:SEKHAR
Authorized Official - Last Name:NAGIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-761-4444
Mailing Address - Street 1:2130 ACADEMY CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1694
Mailing Address - Country:US
Mailing Address - Phone:719-761-4444
Mailing Address - Fax:719-550-4100
Practice Address - Street 1:2130 ACADEMY CIR
Practice Address - Street 2:SUITE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1694
Practice Address - Country:US
Practice Address - Phone:719-761-4444
Practice Address - Fax:719-550-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty