Provider Demographics
NPI:1700819497
Name:COLORADO NEUROPSYCHOLOGICAL & BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:COLORADO NEUROPSYCHOLOGICAL & BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-468-3651
Mailing Address - Street 1:8751 E HAMPDEN AVE STE C2
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4930
Mailing Address - Country:US
Mailing Address - Phone:720-468-3651
Mailing Address - Fax:303-745-3489
Practice Address - Street 1:8751 E HAMPDEN AVE STE C2
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4930
Practice Address - Country:US
Practice Address - Phone:720-468-3651
Practice Address - Fax:720-468-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2506103G00000X, 103TC0700X
CO2539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD07942Medicare PIN
COC809032Medicare PIN