Provider Demographics
NPI:1912645458
Name:COLORADO SPRINGS NEUROLOGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:COLORADO SPRINGS NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-389-1108
Mailing Address - Street 1:2312 N NEVADA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5307
Mailing Address - Country:US
Mailing Address - Phone:719-473-3272
Mailing Address - Fax:
Practice Address - Street 1:2312 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5307
Practice Address - Country:US
Practice Address - Phone:719-473-3272
Practice Address - Fax:719-389-1191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO SPRINGS NEUROLOGICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty