Provider Demographics
NPI:1295040913
Name:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MAHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPA
Authorized Official - Phone:303-724-6327
Mailing Address - Street 1:1784 RACINE ST
Mailing Address - Street 2:ROOM R09-130
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7144
Mailing Address - Country:US
Mailing Address - Phone:303-724-6327
Mailing Address - Fax:303-724-3717
Practice Address - Street 1:1784 RACINE ST
Practice Address - Street 2:ROOM R09-130
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7144
Practice Address - Country:US
Practice Address - Phone:303-724-6327
Practice Address - Fax:303-724-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2926103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty