| Psychodynamics Professional Llc | |
|
2501 Blichmann Avenue Suite 115 Grand Junction CO 81505 | |
| (970) 255-7672 | |
| Not Available |
| Full Name | Psychodynamics Professional Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2501 Blichmann Avenue, Grand Junction, Colorado |
| Authorized Official Name and Position | Jennifer Kennedy (SOLE MEMBER AND MANAGER) |
| Authorized Official Contact | 9702557672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychodynamics Professional Llc Po Box 634 Grand Junction CO 81502-0634 Ph: (970) 255-7672 | Psychodynamics Professional Llc 2501 Blichmann Avenue Suite 115 Grand Junction CO 81505 Ph: (970) 255-7672 |
| NPI Number | 1013494897 |
|---|---|
| Provider Enumeration Date | 07/24/2018 |
| Last Update Date | 07/24/2018 |
| Medicare PECOS PAC ID | 2365796562 |
|---|---|
| Medicare Enrollment ID | O20181106002059 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013494897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 35788 (Colorado) | Primary |
| Provider Name | Jennifer E Kennedy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174690044 PECOS PAC ID: 4789866948 Enrollment ID: I20181106002505 |
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