Provider Demographics
NPI:1912174459
Name:COLORADO CENTER FOR BIOBEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:COLORADO CENTER FOR BIOBEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-449-2364
Mailing Address - Street 1:1229 KALMIA AVE.
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1310
Mailing Address - Country:US
Mailing Address - Phone:303-449-8815
Mailing Address - Fax:720-524-6965
Practice Address - Street 1:1229 KALMIA AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1810
Practice Address - Country:US
Practice Address - Phone:303-449-8815
Practice Address - Fax:720-524-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO322103TC0700X
CO164192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC15604Medicare PIN