Provider Demographics
NPI:1477607554
Name:DURANGO PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DURANGO PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COTGAGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-259-4770
Mailing Address - Street 1:1 MERCADO ST STE 265
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-259-4770
Mailing Address - Fax:970-247-8502
Practice Address - Street 1:1 MERCADO ST STE 265
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-259-4770
Practice Address - Fax:970-247-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty