1861657967 NPI number — MANN COUNSELING GROUP, P.C.

Table of content: (NPI 1861657967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861657967 NPI number — MANN COUNSELING GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANN COUNSELING GROUP, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCDONALD FAMILY COUNSELING, P.C.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861657967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7139 S HUDSON CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122-2541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-881-0854
Provider Business Mailing Address Fax Number:
303-200-8092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7860 E BERRY PL
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-881-0854
Provider Business Practice Location Address Fax Number:
303-200-8092
Provider Enumeration Date:
07/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MANN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-881-0854

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  992561 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 992561 . This is a "LICENSE IN CLINICAL SOCIAL WORK, STATE LICENSE NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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