Provider Demographics
NPI:1760685853
Name:COLORADO NEUROBEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:COLORADO NEUROBEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-482-8095
Mailing Address - Street 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 618
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:720-482-8095
Mailing Address - Fax:720-529-1557
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 618
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:720-482-8095
Practice Address - Fax:720-529-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2264103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty