Provider Demographics
NPI:1245512623
Name:MONDO, COLLEEN (PHD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MONDO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:CLEERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3500 JOHN F KENNEDY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2635
Mailing Address - Country:US
Mailing Address - Phone:970-658-0465
Mailing Address - Fax:888-494-3756
Practice Address - Street 1:3500 JOHN F KENNEDY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2635
Practice Address - Country:US
Practice Address - Phone:970-658-0465
Practice Address - Fax:888-494-3756
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY4632103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent