| Carol Hathaway-clark, Ph.d., Llc | |
|
3393 Iris Ave Ste 104 Boulder CO 80301-1956 | |
| (303) 440-0295 | |
| Not Available |
| Full Name | Carol Hathaway-clark, Ph.d., Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3393 Iris Ave Ste 104, Boulder, Colorado |
| Authorized Official Name and Position | Carol Hathaway-clark (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3034400295 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol Hathaway-clark, Ph.d., Llc 3393 Iris Ave Ste 104 Boulder CO 80301-1956 Ph: (303) 440-0295 | Carol Hathaway-clark, Ph.d., Llc 3393 Iris Ave Ste 104 Boulder CO 80301-1956 Ph: (303) 440-0295 |
| NPI Number | 1558595181 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 05/11/2009 |
| Medicare PECOS PAC ID | 0749339349 |
|---|---|
| Medicare Enrollment ID | O20090529000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558595181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1789 (Colorado) | Primary |
| Provider Name | Carol L Hathaway Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649467663 PECOS PAC ID: 1355439142 Enrollment ID: I20071112000523 |
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