Provider Demographics
NPI:1336947365
Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Entity type:Organization
Organization Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-502-3194
Mailing Address - Street 1:100 W PIKES PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3305
Mailing Address - Country:US
Mailing Address - Phone:719-502-3194
Mailing Address - Fax:
Practice Address - Street 1:100 W PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3305
Practice Address - Country:US
Practice Address - Phone:719-502-3194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIKES PEAK STATE COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-05
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health