Healthcare Provider Details

I. General information

NPI: 1144601873
Provider Name (Legal Business Name): MAIREAD KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR SUITE#940
DENVER CO
80246-1518
US

IV. Provider business mailing address

7395 E QUINCY AVE APT 308
DENVER CO
80237-2258
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-7108
  • Fax:
Mailing address:
  • Phone: 720-335-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA0007077
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: