Provider Demographics
NPI:1851684013
Name:NEUROPSYCHOLOGICAL CONSULTS OF NORTHERN COLORADO LLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL CONSULTS OF NORTHERN COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ST CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-631-7133
Mailing Address - Street 1:PO BOX 7219
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-7219
Mailing Address - Country:US
Mailing Address - Phone:970-631-7133
Mailing Address - Fax:
Practice Address - Street 1:155 BOARDWALK DR
Practice Address - Street 2:SUITE 418
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3040
Practice Address - Country:US
Practice Address - Phone:970-631-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty