Provider Demographics
NPI:1275260770
Name:HIDDEN PEAKS PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:HIDDEN PEAKS PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONSBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-340-8290
Mailing Address - Street 1:3855 AMBROSIA ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3959
Mailing Address - Country:US
Mailing Address - Phone:720-340-8290
Mailing Address - Fax:
Practice Address - Street 1:3855 AMBROSIA ST STE 302
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3959
Practice Address - Country:US
Practice Address - Phone:720-340-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty