Provider Demographics
NPI:1366802308
Name:COLORADO NEUROPSYCHOLOGY SERVICES LLC
Entity type:Organization
Organization Name:COLORADO NEUROPSYCHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINSBURG STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:303-474-4055
Mailing Address - Street 1:255 CANYON BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4979
Mailing Address - Country:US
Mailing Address - Phone:303-474-4055
Mailing Address - Fax:720-638-3699
Practice Address - Street 1:255 CANYON BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4979
Practice Address - Country:US
Practice Address - Phone:303-474-4055
Practice Address - Fax:720-638-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO659509Medicaid