Provider Demographics
NPI:1689102568
Name:2 PEAKS CENTER FOR NEURO PSYCHOLOGY
Entity Type:Organization
Organization Name:2 PEAKS CENTER FOR NEURO PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-714-9823
Mailing Address - Street 1:15873 LINTON LANE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-2134
Mailing Address - Country:US
Mailing Address - Phone:970-797-0446
Mailing Address - Fax:970-631-8343
Practice Address - Street 1:2001 S SHIELDS STREET
Practice Address - Street 2:BLDG A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-797-0446
Practice Address - Fax:970-631-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty