Healthcare Provider Details

I. General information

NPI: 1528082179
Provider Name (Legal Business Name): BONNIE MUCKLOW LPC, LMFT, CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E BELLEVIEW AVE STE 203
GREENWOOD VILLAGE CO
80111-1622
US

IV. Provider business mailing address

7000 E BELLEVIEW AVE STE 203
GREENWOOD VILLAGE CO
80111-1622
US

V. Phone/Fax

Practice location:
  • Phone: 720-488-3822
  • Fax: 303-798-3883
Mailing address:
  • Phone: 720-488-3822
  • Fax: 303-798-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: