Healthcare Provider Details

I. General information

NPI: 1285988741
Provider Name (Legal Business Name): CASEY LYN DONNER PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 E ILIFF AVE
DENVER CO
80231
US

IV. Provider business mailing address

5559 S SKYLINE DR
EVERGREEN CO
80439-5417
US

V. Phone/Fax

Practice location:
  • Phone: 303-636-5600
  • Fax:
Mailing address:
  • Phone: 850-803-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0012816
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: