Provider Demographics
NPI:1104165240
Name:NEURO HOPE PSYCHOTHERAPY & NEUROFEEDBACK PLLC
Entity type:Organization
Organization Name:NEURO HOPE PSYCHOTHERAPY & NEUROFEEDBACK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONACK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-323-3094
Mailing Address - Street 1:7730 N UNION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4075
Mailing Address - Country:US
Mailing Address - Phone:719-323-3094
Mailing Address - Fax:719-266-1773
Practice Address - Street 1:7680 GODDARD ST STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8233
Practice Address - Country:US
Practice Address - Phone:719-323-3094
Practice Address - Fax:719-266-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-09
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12736251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health