| Western Slope Innerchange | |
|
115 Grand Ave Ste 1 Delta CO 81416-2017 | |
| (970) 874-0875 | |
| (970) 874-5443 |
| Full Name | Western Slope Innerchange |
|---|---|
| Speciality | Psychologist |
| Location | 115 Grand Ave Ste 1, Delta, Colorado |
| Authorized Official Name and Position | Brenda K Holland (PRESIDENT) |
| Authorized Official Contact | 9708740875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Slope Innerchange 115 Grand Ave Ste 1 Delta CO 81416-2017 Ph: (970) 874-0875 | Western Slope Innerchange 115 Grand Ave Ste 1 Delta CO 81416-2017 Ph: (970) 874-0875 |
| NPI Number | 1568668341 |
|---|---|
| Provider Enumeration Date | 06/27/2007 |
| Last Update Date | 05/06/2016 |
| Medicare PECOS PAC ID | 0941301261 |
|---|---|
| Medicare Enrollment ID | O20070730000912 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568668341 | NPI | - | NPPES |
| 035354 | Other | CO | VALUE OPTIONS MEDICAID NUMBER |
| 07014905 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 3712 (Colorado) | Secondary |
| 103T00000X | Psychologist | 1490 (Colorado) | Primary |
| Provider Name | Brenda K Holland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942276191 PECOS PAC ID: 1557327798 Enrollment ID: I20041208001021 |
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