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Individual

COLIN MAYNARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
5526 N ACADEMY BLVD STE 109, COLORADO SPRINGS, CO 80918-3688
(719) 301-5100
(719) 960-2649
Mailing address
6070 TRADITIONS DR, COLORADO SPRINGS, CO 80924-6035
(719) 301-5100
(719) 960-2649

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
16-12494
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790211605
CO
Enumeration date
01/08/2018
Last updated
02/10/2020
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