MEDICARE: MRS. NANCY MARIE MCKELVEY LCSW

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	1041C0700X	Clinical Social Worker	373	CO

General Provider Information

NPI Number	:	1811033251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY MARIE MCKELVEY LCSW

Provider Business Mailing Address
First Line	:	149 W HARVARD ST STE 201
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2186
Country	:	US
Telephone Number	:	970-484-3009
Fax Number	:	970-482-0382

Provider Business Practice Location Address
First Line	:	149 W HARVARD ST STE 201
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2186
Country	:	US
Telephone Number	:	970-484-3009
Fax Number	:	970-482-0382

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/09/2007

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