Provider Demographics
NPI:1699098194
Name:FOOTHILLS PSYCHOLOGICAL GROUP
Entity type:Organization
Organization Name:FOOTHILLS PSYCHOLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERRITSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-499-2217
Mailing Address - Street 1:1062 LOVE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2975
Mailing Address - Country:US
Mailing Address - Phone:303-494-4181
Mailing Address - Fax:303-499-2217
Practice Address - Street 1:2501 WALNUT ST
Practice Address - Street 2:STE 202
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5751
Practice Address - Country:US
Practice Address - Phone:303-473-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty