Healthcare Provider Details

I. General information

NPI: 1013077957
Provider Name (Legal Business Name): KIM NOVAK M.A., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FIRESTONE BLVD
FIRESTONE CO
80504-6605
US

IV. Provider business mailing address

PO BOX 314
FIRESTONE CO
80520-0314
US

V. Phone/Fax

Practice location:
  • Phone: 303-579-6975
  • Fax:
Mailing address:
  • Phone: 303-579-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5810
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: