Provider Demographics
NPI:1942495049
Name:NORTHERN COLORADO PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO PSYCHOLOGICAL SERVICES LLC
Other - Org Name:KEN KIRCHNER PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-322-2600
Mailing Address - Street 1:77-137 KALANIUKA ST.
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725-9729
Mailing Address - Country:US
Mailing Address - Phone:808-322-2600
Mailing Address - Fax:808-322-2071
Practice Address - Street 1:77-137 KALANIUKA ST.
Practice Address - Street 2:
Practice Address - City:HOLUALOA
Practice Address - State:HI
Practice Address - Zip Code:96725-9729
Practice Address - Country:US
Practice Address - Phone:808-322-2600
Practice Address - Fax:808-322-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI710103T00000X
CO474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101440Medicare PIN
HIR19071Medicare UPIN
HIH101439Medicare PIN