NPIMap

Organization Active NPI

Cheyenne Mountain Psychological Associates P.C.

  • Clinical Psychologist
  • Colorado Springs, CO
National Provider Identifier
1629410485
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2065 Issued in CO
Legal business name
CHEYENNE MOUNTAIN PSYCHOLOGICAL ASSOCIATES P.C.
Practice address
1830 Parkview Blvd
Colorado Springs, CO 80905-7629
Phone
(719) 635-3453
NPI assigned
Jul 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raye Lynne Dippel, PH.D
Title
Owner
Phone
(719) 635-3453

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 2065 CO Primary

Addresses

Primary practice location

1830 Parkview Blvd
Colorado Springs, CO 80905-7629

Mailing address

1830 Parkview Blvd
Colorado Springs, CO 80905-7629
Phone (719) 635-3453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141229001353 CO Part B Supplier - Clinic/Group Practice 7911220884 Practice locations: Colorado Springs, CO

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1629410485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 PARKVIEW BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809057629",
            "telephone_number": "719-635-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 PARKVIEW BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809057629",
            "telephone_number": "719-635-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE MOUNTAIN PSYCHOLOGICAL ASSOCIATES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-22",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "DIPPEL",
        "authorized_official_first_name": "RAYE",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-635-3453",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "2065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.