Basic Information
| Provider Information | |||||||||
| NPI: | 1932500840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEGASUS EQUINE THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16659 6250 RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814037822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705962493 | ||||||||
| FaxNumber: | 9702491576 | ||||||||
| Practice Location | |||||||||
| Address1: | 16659 6250 RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814037822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705962493 | ||||||||
| FaxNumber: | 9702491576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | KAY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9705962493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW.00876063 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.