Healthcare Provider Details

I. General information

NPI: 1295474591
Provider Name (Legal Business Name): KATHRYN MANGANO AMES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 S JASMINE ST
CENTENNIAL CO
80111-4228
US

IV. Provider business mailing address

5907 S JASMINE ST
CENTENNIAL CO
80111-4228
US

V. Phone/Fax

Practice location:
  • Phone: 303-802-9777
  • Fax:
Mailing address:
  • Phone: 303-802-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003429
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: