| Southpointe Family Resource Center, P.c. | |
|
4710 Table Mesa Dr Ste B Boulder CO 80305-4504 | |
| (402) 432-3629 | |
| (303) 200-7218 |
| Full Name | Southpointe Family Resource Center, P.c. |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4710 Table Mesa Dr Ste B, Boulder, Colorado |
| Authorized Official Name and Position | Karen Kay Sharer-mohatt (PRESIDENT) |
| Authorized Official Contact | 4024323629 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southpointe Family Resource Center, P.c. 435 Short Dr Dacono CO 80514-5040 Ph: (402) 432-3629 | Southpointe Family Resource Center, P.c. 4710 Table Mesa Dr Ste B Boulder CO 80305-4504 Ph: (402) 432-3629 |
| NPI Number | 1699822981 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 02/12/2021 |
| Certification Date | 01/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699822981 | NPI | - | NPPES |
| 1114002102 | Other | NE | INDIVIDUAL NPI |
| 27350 | Other | NE | PTAN |
| 098990 | Other | NE | PTAN |
| 1982293734 | Other | CO | NPI |
| 1699822971 | Other | NE | GROUP NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 445 (Nebraska) | Primary |
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