Provider Demographics
NPI:1316368996
Name:PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:720-937-9758
Mailing Address - Street 1:420 E 58TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-1400
Mailing Address - Country:US
Mailing Address - Phone:720-854-0262
Mailing Address - Fax:720-854-0263
Practice Address - Street 1:420 E 58TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-1400
Practice Address - Country:US
Practice Address - Phone:720-854-0262
Practice Address - Fax:720-854-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2519261QM0801X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder