Basic Information
| Provider Information | |||||||||
| NPI: | 1891767950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODSHALL | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 COCHRANE CIRCLE | ||||||||
| Address2: | EBHS-3, DBH, EACH | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195260175 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7500 COCHRANE CIRCLE | ||||||||
| Address2: | EBHS-3, DBH, EACH | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195260175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY2940 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 253 | WY | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.