Basic Information
| Provider Information | |||||||||
| NPI: | 1346742368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANNELL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S., LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 FLINTRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809184307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192379129 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5350 N ACADEMY BLVD STE 1100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809184098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192661000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2018 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-15-07790 | CO | N | 101YM0800X | LPCC.0015731 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.