Healthcare Provider Details

I. General information

NPI: 1205881364
Provider Name (Legal Business Name): STEPHANIE LYNN MEHLECK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD SUITE B-206
DENVER CO
80222-3303
US

IV. Provider business mailing address

1325 S. COLORADO BLVD. SUITE B-206
DENVER CO
80222
US

V. Phone/Fax

Practice location:
  • Phone: 303-753-6611
  • Fax:
Mailing address:
  • Phone: 303-753-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: