MEDICARE: DR. SAMUEL KOHLENBERG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.0012136	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC0012136	OTHER	CO	LPC

General Provider Information

NPI Number	:	1265724439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL KOHLENBERG LPC

Provider Business Mailing Address
First Line	:	2450 S VINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 S VINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5264
Country	:	US
Telephone Number	:	303-871-3626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	06/17/2025

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