Provider Demographics
NPI:1891874616
Name:SLICTON, DARLA J (PSYD, LPC, PSY)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:J
Last Name:SLICTON
Suffix:
Gender:F
Credentials:PSYD, LPC, PSY
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:
Other - Last Name:LEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4810 SETON PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5205
Mailing Address - Country:US
Mailing Address - Phone:719-593-0000
Mailing Address - Fax:
Practice Address - Street 1:2864 S CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4114
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4223101YP2500X
COPSY.0004454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional