Organization
SOARING EAGLES CENTER FOR AUTISM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN W. COLVIN M.D. (EXECUTIVE DIRECTOR)
(719) 547-8803
Entity
Organization
Contact information
Practice address
125 W PALMER LAKE DR, PUEBLO WEST, CO 81007-2876
(719) 547-8803
(719) 547-8806
Mailing address
PO BOX 7878, PUEBLO WEST, CO 81007-0878
(719) 547-8803
(719) 547-8806
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
34666
CO
103K00000X
Behavior Analyst
Primary
1-17-30000
CO
251S00000X
Community/Behavioral Health Agency
34666
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80986226
—
CO
Enumeration date
02/21/2008
Last updated
03/26/2018
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