Provider Demographics
NPI:1538689195
Name:PUEBLO PIONEER PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:PUEBLO PIONEER PSYCHOLOGY LLC
Other - Org Name:PUEBLO PIONEER PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-470-0540
Mailing Address - Street 1:1124 EAGLERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2103
Mailing Address - Country:US
Mailing Address - Phone:719-470-0514
Mailing Address - Fax:
Practice Address - Street 1:1124 EAGLERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2103
Practice Address - Country:US
Practice Address - Phone:719-470-0514
Practice Address - Fax:719-960-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty