Provider Demographics
NPI:1528498078
Name:ARKANSAS PEAK PSYCHOLOGICAL SERVICES, PPLC
Entity type:Organization
Organization Name:ARKANSAS PEAK PSYCHOLOGICAL SERVICES, PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-291-8915
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1268
Mailing Address - Country:US
Mailing Address - Phone:720-291-8915
Mailing Address - Fax:719-635-8631
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:SUITE 326
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3130
Practice Address - Country:US
Practice Address - Phone:720-291-8915
Practice Address - Fax:719-635-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty