Provider Demographics
NPI:1952051864
Name:WESTERN SLOPE PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:WESTERN SLOPE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-275-2778
Mailing Address - Street 1:917 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3538
Mailing Address - Country:US
Mailing Address - Phone:970-275-2778
Mailing Address - Fax:
Practice Address - Street 1:917 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3538
Practice Address - Country:US
Practice Address - Phone:970-275-2778
Practice Address - Fax:970-609-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty