Provider Demographics
NPI:1417098781
Name:ADRIENNE MARKS PHD P.C.
Entity Type:Organization
Organization Name:ADRIENNE MARKS PHD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-539-6160
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201
Mailing Address - Country:US
Mailing Address - Phone:719-539-6160
Mailing Address - Fax:719-539-7151
Practice Address - Street 1:225 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201
Practice Address - Country:US
Practice Address - Phone:719-539-6160
Practice Address - Fax:719-539-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC82286OtherPTAN
CO0400020Medicaid
COC82286OtherPTAN
COC82286Medicare UPIN
R20198Medicare UPIN