Basic Information
| Provider Information | |||||||||
| NPI: | 1154896652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUYETTE | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2541 PLUMTREE GRV | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809075949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035326520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17230 JACKSON CREEK PKWY STE 220 | ||||||||
| Address2: | |||||||||
| City: | MONUMENT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801327304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194883348 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-20-41560 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.