Provider Demographics
NPI:1942024773
Name:DYNAMIC PSYCHOLOGY ASSESSMENT, PLLC
Entity type:Organization
Organization Name:DYNAMIC PSYCHOLOGY ASSESSMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-396-2039
Mailing Address - Street 1:6510 S ACADEMY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8691
Mailing Address - Country:US
Mailing Address - Phone:719-396-2039
Mailing Address - Fax:
Practice Address - Street 1:6937 SHEA DR APT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80902-7335
Practice Address - Country:US
Practice Address - Phone:341-600-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health