Provider Demographics
NPI:1932647146
Name:COLORADO STATE UNIVERSITY
Entity Type:Organization
Organization Name:COLORADO STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-491-5212
Mailing Address - Street 1:1876 CAMPUS DELIVERY
Mailing Address - Street 2:COLORADO STATE UNIVERSITY
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-1876
Mailing Address - Country:US
Mailing Address - Phone:970-416-6115
Mailing Address - Fax:
Practice Address - Street 1:1876 CAMPUS DELIVERY
Practice Address - Street 2:COLORADO STATE UNIVERSITY
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-1876
Practice Address - Country:US
Practice Address - Phone:970-416-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0003880251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health