Organization Name: | CLINICAL PSYCHOLOGIST PLLC |
NPI Number: | 1003217019 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PEPE SANTANA (CEO) |
Mailing Address: | 90 Madison St Suite 402 Denver |
State: | CO US |
Postal Code: | 802065418 |
Phone Number: | 7202720565 |
Fax Number: | |
NPI Enumeration Date: | 09/09/2014 |
NPI Last Update Date: | 09/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |