Provider Demographics
NPI:1396119020
Name:SUTHERLAND PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:SUTHERLAND PSYCHOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:719-471-0800
Mailing Address - Street 1:509 SCOTT AVE
Mailing Address - Street 2:SUITE 136
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-1293
Mailing Address - Country:US
Mailing Address - Phone:719-471-0800
Mailing Address - Fax:719-471-0808
Practice Address - Street 1:225 S ACADEMY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2768
Practice Address - Country:US
Practice Address - Phone:719-471-0800
Practice Address - Fax:719-471-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY-0003464103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty