MEDICARE: KATHI LYNN FANNING 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	1008	CO

General Provider Information

NPI Number	:	1881298669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHI LYNN FANNING LPC

Provider Business Mailing Address
First Line	:	PO BOX 18975
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-0975
Country	:	US
Telephone Number	:	303-860-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 N GILPIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1205
Country	:	US
Telephone Number	:	303-860-0660
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/24/2021

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