Healthcare Provider Details

I. General information

NPI: 1275196990
Provider Name (Legal Business Name): DORA MCGILL MFTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 N ACADEMY BLVD STE 290
COLORADO SPRINGS CO
80918-4038
US

IV. Provider business mailing address

5360 N ACADEMY BLVD STE 290
COLORADO SPRINGS CO
80918-4038
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-2061
  • Fax: 719-434-2275
Mailing address:
  • Phone: 719-434-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0013890
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0013890
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: