1952651861 NPI number — NANCY O. READ, PHD, LICENSED PSYCHOLOGIST, PLLC

Table of content: MRS. AMANDA DE LA MORA PCCI (NPI 1316302904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952651861 NPI number — NANCY O. READ, PHD, LICENSED PSYCHOLOGIST, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY O. READ, PHD, LICENSED PSYCHOLOGIST, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952651861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4232
Provider Second Line Business Mailing Address:
100 W. COLORADO AVE, SUITE 240F
Provider Business Mailing Address City Name:
TELLURIDE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81435-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-355-0536
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W. COLORADO AVE
Provider Second Line Business Practice Location Address:
SUITE 240F
Provider Business Practice Location Address City Name:
TELLURIDE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-355-0536
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
READ
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
OLIVER
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
218-355-0536

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3734 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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