Provider Demographics
NPI:1992213748
Name:O'DONNELL, COLLEEN RYAN (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:RYAN
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 E ARAPAHOE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1548
Mailing Address - Country:US
Mailing Address - Phone:720-295-4703
Mailing Address - Fax:
Practice Address - Street 1:2305 E ARAPAHOE RD STE 250
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1548
Practice Address - Country:US
Practice Address - Phone:720-295-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist