Provider Demographics
NPI:1437560760
Name:THERESA M. GISI, LLC
Entity type:Organization
Organization Name:THERESA M. GISI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GISI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-641-0222
Mailing Address - Street 1:17730 SMUGGLERS RD
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8517
Mailing Address - Country:US
Mailing Address - Phone:719-641-0222
Mailing Address - Fax:719-623-0008
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:200B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-641-0222
Practice Address - Fax:719-623-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty