Provider Demographics
NPI:1013147636
Name:DEB ELLIOTT-DESORBO, PH.D., LLC
Entity type:Organization
Organization Name:DEB ELLIOTT-DESORBO, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT-DESORBO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-332-5177
Mailing Address - Street 1:PO BOX 62342
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2342
Mailing Address - Country:US
Mailing Address - Phone:719-332-5177
Mailing Address - Fax:
Practice Address - Street 1:6455 N UNION BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5852
Practice Address - Country:US
Practice Address - Phone:719-332-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY-3210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty