Provider Demographics
NPI:1962670786
Name:MANN, DALE P (PHD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:P
Last Name:MANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N CIRCLE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1182
Mailing Address - Country:US
Mailing Address - Phone:719-776-4811
Mailing Address - Fax:719-776-4860
Practice Address - Street 1:3010 N CIRCLE DR STE 120
Practice Address - Street 2:#100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1182
Practice Address - Country:US
Practice Address - Phone:719-776-4811
Practice Address - Fax:719-776-4860
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO677103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist