Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2193 | CO |
N | 103T00000X | Psychologist | 2193 | CO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2193 | CO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2193 | CO |
NPI | 1114033131 |
---|---|
Provider Name | Dr. David Louis Nahum |
First Address | Castle Rock, CO 80109-3132 |
Second Address | Castle Rock, CO 80109-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
248039 | GREAT-WEST (01) | CO |
248039 | VALUE OPTIONS (01) | CO |