| Psychological Services, P.c. | |
|
613 Walnut St Boulder CO 80302-5031 | |
| (303) 443-1223 | |
| (303) 473-9153 |
| Full Name | Psychological Services, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 613 Walnut St, Boulder, Colorado |
| Authorized Official Name and Position | Joan C. Soper (VP) |
| Authorized Official Contact | 3034431223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Services, P.c. 613 Walnut St Boulder CO 80302-5031 Ph: (303) 443-1223 | Psychological Services, P.c. 613 Walnut St Boulder CO 80302-5031 Ph: (303) 443-1223 |
| NPI Number | 1679522817 |
|---|---|
| Provider Enumeration Date | 05/06/2006 |
| Last Update Date | 12/20/2011 |
| Medicare PECOS PAC ID | 9638069883 |
|---|---|
| Medicare Enrollment ID | O20040319000391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679522817 | NPI | - | NPPES |
| 04010732 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 633 AND 1746 (Colorado) | Primary |
| Provider Name | Ernest T Soper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881642825 PECOS PAC ID: 3779473921 Enrollment ID: I20120220001066 |
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