Provider Demographics
NPI:1972139467
Name:ALPENGLOW PSYCH, PLLC
Entity Type:Organization
Organization Name:ALPENGLOW PSYCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ZANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:970-310-4389
Mailing Address - Street 1:PO BOX 272213
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-2213
Mailing Address - Country:US
Mailing Address - Phone:970-310-4389
Mailing Address - Fax:
Practice Address - Street 1:2004 W 15TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3551
Practice Address - Country:US
Practice Address - Phone:970-310-4389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1992086839Medicaid