Provider Demographics
NPI:1912464777
Name:COLORADO SEMINARY
Entity Type:Organization
Organization Name:COLORADO SEMINARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSAVAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-871-3230
Mailing Address - Street 1:1999 E. EVANS AVENUE
Mailing Address - Street 2:ATTN: ANDI PUSAVAT, KRH RM. 145
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208
Mailing Address - Country:US
Mailing Address - Phone:303-871-3230
Mailing Address - Fax:
Practice Address - Street 1:1999 E. EVANS AVENUE
Practice Address - Street 2:ATTN: ANDI PUSAVAT, KRH RM. 145
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80208
Practice Address - Country:US
Practice Address - Phone:303-871-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO SEMINARY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty