Healthcare Provider Details

I. General information

NPI: 1578201760
Provider Name (Legal Business Name): MARK N CADLAON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E PRENTICE AVE STE 300
GREENWOOD VILLAGE CO
80111-2906
US

IV. Provider business mailing address

6429 S VINEWOOD ST APT 202
LITTLETON CO
80120-1824
US

V. Phone/Fax

Practice location:
  • Phone: 720-489-8555
  • Fax:
Mailing address:
  • Phone: 606-923-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0019645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: