MEDICARE: MS. NANCILEE PATRICE KORTH 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	0004174	CO

General Provider Information

NPI Number	:	1457786923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCILEE PATRICE KORTH LPC

Provider Business Mailing Address
First Line	:	1325 S COLORADO BLVD STE 509
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3320
Country	:	US
Telephone Number	:	720-570-9333
Fax Number	:	720-570-9339

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE 509
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3320
Country	:	US
Telephone Number	:	720-570-9333
Fax Number	:	720-570-9339

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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