Provider Demographics
NPI:1629410485
Name:CHEYENNE MOUNTAIN PSYCHOLOGICAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN PSYCHOLOGICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-635-3453
Mailing Address - Street 1:1830 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7629
Mailing Address - Country:US
Mailing Address - Phone:719-635-3453
Mailing Address - Fax:
Practice Address - Street 1:1830 PARKVIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7629
Practice Address - Country:US
Practice Address - Phone:719-635-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty