Provider Demographics
NPI:1619502838
Name:UTE PASS PSYCHOLOGICAL CONSULTATION
Entity Type:Organization
Organization Name:UTE PASS PSYCHOLOGICAL CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-484-9334
Mailing Address - Street 1:900 TAMARAC PKWY UNIT 7122
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-7776
Mailing Address - Country:US
Mailing Address - Phone:719-484-9334
Mailing Address - Fax:
Practice Address - Street 1:900 TAMARAC PKWY UNIT 7122
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7776
Practice Address - Country:US
Practice Address - Phone:719-484-9334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSY.0003464OtherDORA