Provider Demographics
NPI:1376933168
Name:MARIA L. OTT, PSY. D., P.C.
Entity Type:Organization
Organization Name:MARIA L. OTT, PSY. D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-465-4340
Mailing Address - Street 1:6455 BLUFFMONT PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-8401
Mailing Address - Country:US
Mailing Address - Phone:719-465-4340
Mailing Address - Fax:
Practice Address - Street 1:2860 S CIRCLE DR
Practice Address - Street 2:100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4113
Practice Address - Country:US
Practice Address - Phone:719-465-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO143191Medicaid
COC811047OtherPTAN