Provider Demographics
NPI:1699373621
Name:COLORADO SPRINGS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:COLORADO SPRINGS PSYCHOLOGICAL SERVICES
Other - Org Name:BRAIN AND BODY INTEGRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-357-6471
Mailing Address - Street 1:1115 ELKTON DR STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3597
Mailing Address - Country:US
Mailing Address - Phone:719-357-6471
Mailing Address - Fax:
Practice Address - Street 1:6000 E EVANS AVE STE 350
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5406
Practice Address - Country:US
Practice Address - Phone:719-357-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty