Healthcare Provider Details

I. General information

NPI: 1881196657
Provider Name (Legal Business Name): LAUREN CIOVACCO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone: 303-504-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: