Healthcare Provider Details

I. General information

NPI: 1982174728
Provider Name (Legal Business Name): SHANE FALKENHART LPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E 17TH AVE STE 1
DENVER CO
80206-1813
US

IV. Provider business mailing address

722 ELATI ST
DENVER CO
80204-4538
US

V. Phone/Fax

Practice location:
  • Phone: 720-434-9800
  • Fax:
Mailing address:
  • Phone: 720-434-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0016350
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001139
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: