Provider Demographics
NPI:1376785907
Name:NEURODEVELOPMENT CENTER OF COLORADO
Entity Type:Organization
Organization Name:NEURODEVELOPMENT CENTER OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKALICKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-282-4428
Mailing Address - Street 1:608 E. HARMONY #202
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3210
Mailing Address - Country:US
Mailing Address - Phone:970-282-4428
Mailing Address - Fax:970-282-4393
Practice Address - Street 1:608 E. HARMONY #202
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3210
Practice Address - Country:US
Practice Address - Phone:970-282-4428
Practice Address - Fax:970-282-4393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2843103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty