Provider Demographics
NPI:1851479091
Name:PSYCHOGNOSIS, LLC
Entity Type:Organization
Organization Name:PSYCHOGNOSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-272-9272
Mailing Address - Street 1:2774 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6345
Mailing Address - Country:US
Mailing Address - Phone:720-272-9272
Mailing Address - Fax:
Practice Address - Street 1:8670 WOLFF CT
Practice Address - Street 2:SUITE #130
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6956
Practice Address - Country:US
Practice Address - Phone:720-272-9272
Practice Address - Fax:720-272-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty