Provider Demographics
NPI:1790771780
Name:ARCHAMBEAU, ELAINE (PHD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:ARCHAMBEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CHEYENNE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2423
Mailing Address - Country:US
Mailing Address - Phone:520-780-0509
Mailing Address - Fax:
Practice Address - Street 1:730 CHEYENNE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-2423
Practice Address - Country:US
Practice Address - Phone:520-780-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2021-01-25
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
HI1438103T00000X
AZ3522103T00000X
CO0000775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000775OtherLICENSE