Provider Demographics
NPI:1912069576
Name:PATRICIA WINTER PHD PC
Entity Type:Organization
Organization Name:PATRICIA WINTER PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-239-0765
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:502 ANTERO CIRCLE, SUITE 1
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-1737
Mailing Address - Country:US
Mailing Address - Phone:719-395-8200
Mailing Address - Fax:719-395-8200
Practice Address - Street 1:502 ANTERO CIRCLE, SUITE 1
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-8200
Practice Address - Fax:719-395-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO126000OtherVALUEOPTIONS
CO126000OtherVALUEOPTIONS