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56 Club Manor Dr Ste 100 Pueblo CO 81008-1679 | |
| (719) 584-4767 | |
| (719) 584-4808 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Health Service |
| Location | 56 Club Manor Dr, Pueblo, Colorado |
| Authorized Official Name and Position | William Patterson (CFO) |
| Authorized Official Contact | 7195844000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1600 N Grand Ave Ste 150 Pueblo CO 81003-2700 Ph: (719) 595-7705 | 56 Club Manor Dr Ste 100 Pueblo CO 81008-1679 Ph: (719) 584-4767 |
| NPI Number | 1992972731 |
|---|---|
| Provider Enumeration Date | 05/12/2008 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992972731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | (* (Not Available)) | Primary |
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