Individual
DR. PHILADELPHIA COUSINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4251 KIPLING ST, SUITE 345, WHEAT RIDGE, CO 80033-2896
(303) 421-3811
Mailing address
4251 KIPLING ST, 345, WHEAT RIDGE, CO 80033-2896
(303) 421-3811
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1051
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89996
BLUE CROSS BLUE SHIELD ID
CO
Enumeration date
04/08/2007
Last updated
07/08/2007
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