Provider Demographics
NPI:1194930396
Name:PSYCHOLOGICAL SERVICES CORPORATION
Entity type:Organization
Organization Name:PSYCHOLOGICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-448-4915
Mailing Address - Street 1:1750 30TH ST
Mailing Address - Street 2:PMB 139
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1029
Mailing Address - Country:US
Mailing Address - Phone:303-448-4915
Mailing Address - Fax:303-444-2372
Practice Address - Street 1:2955 VALMONT RD
Practice Address - Street 2:STE 230
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-448-4915
Practice Address - Fax:303-444-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty