Provider Demographics
NPI:1285216929
Name:PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Entity Type:Organization
Organization Name:PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-924-0484
Mailing Address - Street 1:1001 GRAND AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3642
Mailing Address - Country:US
Mailing Address - Phone:970-924-0484
Mailing Address - Fax:
Practice Address - Street 1:144 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2318
Practice Address - Country:US
Practice Address - Phone:970-665-4744
Practice Address - Fax:970-549-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty