Individual
DR. BRIAN W DESANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D,
Contact information
Practice address
2828 INTERNATIONAL CIR, SUITE 140, COLORADO SPRINGS, CO 80910-3127
(719) 632-5700
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2690
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64456722
—
CO
01
—
COA101696
MEDICARE NUMBER
CO
Enumeration date
12/29/2005
Last updated
04/03/2017
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