Organization
SENIOR HARBORS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERLEY J. GONZALES ED.D. (CEO)
(719) 320-3648
Entity
Organization
Contact information
Practice address
2118 CHATALET LANE, PUEBLO, CO 81005
(719) 320-3648
(719) 543-6432
Mailing address
3031 NORWICH AVE, PUEBLO, CO 81008-1435
(719) 320-3648
(719) 543-6432
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2181
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23489367
—
CO
Enumeration date
10/19/2006
Last updated
09/14/2007
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