Basic Information
| Provider Information | |||||||||
| NPI: | 1467520403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL HEALTH THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4760 FLINTRIDGE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809184264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192606262 | ||||||||
| FaxNumber: | 7192600780 | ||||||||
| Practice Location | |||||||||
| Address1: | 4760 FLINTRIDGE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809184264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192606262 | ||||||||
| FaxNumber: | 7192600780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANDERS | ||||||||
| AuthorizedOfficialFirstName: | DONA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7192606262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1237 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.