Provider Demographics
NPI:1215529300
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:L
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 1:8380 ZUNI ST STE 305
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4689
Practice Address - Country:US
Practice Address - Phone:719-357-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty