Provider Demographics
NPI:1992893598
Name:COLORADO PROFESSIONAL PSYCHOLOGICAL GROUP, P.C.
Entity type:Organization
Organization Name:COLORADO PROFESSIONAL PSYCHOLOGICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-380-0114
Mailing Address - Street 1:4100 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3048
Mailing Address - Country:US
Mailing Address - Phone:303-380-0114
Mailing Address - Fax:303-759-3515
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:303-380-0114
Practice Address - Fax:303-759-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1183261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07011839Medicaid
CO07011839Medicaid
CO87556Medicare ID - Type Unspecified