Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0004271 | CO |
N | 103TC0700X | Clinical Psychologist | 0004271 | CO |
Y | 103TR0400X | Rehabilitation Psychologist | 0004271 | CO |
NPI | 1477980936 |
---|---|
Provider Name | Dr. Shea Mctaggart |
First Address | Denver, CO 80209-2805 |
Second Address | Denver, CO 80209-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2013 |
Last Update Date | 29/11/2016 |