Healthcare Provider Details

I. General information

NPI: 1922580067
Provider Name (Legal Business Name): MARYANNE MEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 W COLORADO AVE STE 200
COLORADO SPRINGS CO
80904-3074
US

IV. Provider business mailing address

2514 W COLORADO AVE STE 200
COLORADO SPRINGS CO
80904-3074
US

V. Phone/Fax

Practice location:
  • Phone: 719-401-2443
  • Fax:
Mailing address:
  • Phone: 719-401-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016817
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: