Provider Demographics
NPI:1982074969
Name:COLORADO SPRINGS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:COLORADO SPRINGS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-357-6471
Mailing Address - Street 1:1115 ELKTON DR STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3884
Mailing Address - Country:US
Mailing Address - Phone:719-357-6471
Mailing Address - Fax:
Practice Address - Street 1:1115 ELKTON DR STE 301
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3884
Practice Address - Country:US
Practice Address - Phone:719-357-6471
Practice Address - Fax:719-631-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13771868Medicaid
CO328720Medicare UPIN