Provider Demographics
NPI:1679612220
Name:CALHOUN, ROBERT WAGNER (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAGNER
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 HIGHLAND PLACE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1551
Mailing Address - Country:US
Mailing Address - Phone:970-484-1481
Mailing Address - Fax:
Practice Address - Street 1:1302 S SHIELDS ST
Practice Address - Street 2:UNIT A2-2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-4801
Practice Address - Country:US
Practice Address - Phone:970-493-8006
Practice Address - Fax:970-493-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC81066Medicare ID - Type Unspecified