Healthcare Provider Details

I. General information

NPI: 1801082250
Provider Name (Legal Business Name): MIMI BRADLEY MCFAUL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 S YOSEMITE ST
CENTENNIAL CO
80112-2026
US

IV. Provider business mailing address

5392 GOLF COURSE DR
MORRISON CO
80465-2148
US

V. Phone/Fax

Practice location:
  • Phone: 720-252-4750
  • Fax:
Mailing address:
  • Phone: 720-252-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3063
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3063
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: