| Broadmoor Psychological Services Llc | |
|
1229 Lake Plaza Dr Ste A Colorado Springs CO 80906-7401 | |
| (719) 900-1301 | |
| (719) 735-4952 |
| Full Name | Broadmoor Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1229 Lake Plaza Dr Ste A, Colorado Springs, Colorado |
| Authorized Official Name and Position | Michelle Wickizer (OWNER) |
| Authorized Official Contact | 7199001301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadmoor Psychological Services Llc Po Box 38553 Colorado Springs CO 80937-8553 Ph: (719) 313-2578 | Broadmoor Psychological Services Llc 1229 Lake Plaza Dr Ste A Colorado Springs CO 80906-7401 Ph: (719) 900-1301 |
| NPI Number | 1932989522 |
|---|---|
| Provider Enumeration Date | 10/02/2023 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 2062869266 |
|---|---|
| Medicare Enrollment ID | O20231109001885 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932989522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Justina M Kropp |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013357243 PECOS PAC ID: 9436455599 Enrollment ID: I20160316000207 |
| Provider Name | Michelle Wickizer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689339905 PECOS PAC ID: 4082003207 Enrollment ID: I20211109003432 |
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