| Doctor Name: | DR. MARK ROLSTEN |
| NPI Number: | 1326055914 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | 3184 |
| Business Practice Address: | 559 Vincent St Attn: 21 Mdos/sgoh-mental Health Peterson Afb, CO - 809141541 |
| Business Phone Number: | 7195567804 |
| Business Fax Number: | 8668677926 |
| Mailing Address: | 559 Vincent St, Attn: 21 Mdos/sgoh-mental Health PETERSON AFB |
| State: | CO |
| Postal Code: | 809141541 |
| Phone Number: | 7195567804 |
| Fax Number: | 8668677926 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 03/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3184 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |