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Individual

AUGUST VANDERBEEK

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PSY D

Contact information

Practice address
75 SOUTH PAGOSA BLVD, PAGOSA SPRINGS, CO 81147
(970) 385-3969
Mailing address
581 RAINBOW DR, PAGOSA SPRINGS, CO 81147
(970) 264-6216

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2354
CO
103T00000X
Psychologist
5010
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
127512
CO
Enumeration date
02/27/2006
Last updated
07/08/2007
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