Healthcare Provider Details

I. General information

NPI: 1457453268
Provider Name (Legal Business Name): MAROLD MINDSET INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 S CIRCLE DR STE 350
COLORADO SPRINGS CO
80906-4114
US

IV. Provider business mailing address

3120 BRADY BLVD
COLORADO SPRINGS CO
80909-2125
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-9211
  • Fax: 719-540-6045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number613
License Number StateCO

VIII. Authorized Official

Name: MARION MAROLD VICKERMAN
Title or Position: OWNER
Credential: LMFT
Phone: 719-660-4039