Provider Demographics
NPI:1962476408
Name:CANTRELL, DAVID PHILLIPS (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILLIPS
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S COLLEGE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3184
Mailing Address - Country:US
Mailing Address - Phone:970-407-2959
Mailing Address - Fax:970-482-7300
Practice Address - Street 1:112 S COLLEGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3184
Practice Address - Country:US
Practice Address - Phone:970-407-2959
Practice Address - Fax:970-482-7300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0219590103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool