| Senior Harbors, Inc. | |
|
2118 Chatalet Lane Pueblo CO 81005 | |
| (719) 320-3648 | |
| (719) 543-6432 |
| Full Name | Senior Harbors, Inc. |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2118 Chatalet Lane, Pueblo, Colorado |
| Authorized Official Name and Position | Sherley J. Gonzales (CEO) |
| Authorized Official Contact | 7193203648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Harbors, Inc. 3031 Norwich Ave Pueblo CO 81008-1435 Ph: (719) 320-3648 | Senior Harbors, Inc. 2118 Chatalet Lane Pueblo CO 81005 Ph: (719) 320-3648 |
| NPI Number | 1114009198 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 09/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114009198 | NPI | - | NPPES |
| 23489367 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2181 (Colorado) | Primary |
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