Active NPI
Ernest T. Soper III, PH.D.
- Clinical Psychologist
- Boulder, CO
National Provider Identifier
1881642825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 633
- Practice address
- 613 Walnut St
Boulder, CO 80302-5031 - Phone
- (303) 443-1223
- Fax
- (303) 473-9153
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 633 | CO | Primary |
Addresses
Primary practice location
613 Walnut St
Boulder, CO 80302-5031
Mailing address
613 Walnut St
Boulder, CO 80302-5031
Phone (303) 443-1223
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07102601 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 633 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324512000000",
"number": "1881642825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 WALNUT ST",
"city": "BOULDER",
"state": "CO",
"postal_code": "803025031",
"telephone_number": "303-443-1223",
"fax_number": "303-473-9153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "613 WALNUT ST",
"city": "BOULDER",
"state": "CO",
"postal_code": "803025031",
"telephone_number": "303-443-1223",
"fax_number": "303-473-9153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOPER",
"first_name": "ERNEST",
"middle_name": "T.",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2011-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07102601",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.