Organization
WESTERN SLOPE INNERCHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDA K HOLLAND PHD (PRESIDENT)
(970) 874-0875
Entity
Organization
Contact information
Practice address
115 GRAND AVE STE 1, DELTA, CO 81416-2017
(970) 874-0875
(970) 874-5443
Mailing address
115 GRAND AVE STE 1, DELTA, CO 81416-2017
(970) 874-0875
(970) 874-5443
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3712
CO
103T00000X
Psychologist
Primary
1490
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
035354
VALUE OPTIONS MEDICAID NUMBER
CO
05
—
07014905
—
CO
Enumeration date
06/27/2007
Last updated
05/06/2016
Update your record
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