Provider Demographics
NPI:1255442612
Name:ELLIOTT-DESORBO, DEBORAH KATHRYN (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHRYN
Last Name:ELLIOTT-DESORBO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KATHRYN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY-3210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical