Healthcare Provider Details

I. General information

NPI: 1669127684
Provider Name (Legal Business Name): ABBY LYNN MOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 W 14TH AVE STE 300
LAKEWOOD CO
80215-4848
US

IV. Provider business mailing address

211 LEWIS ST
CASTLE ROCK CO
80104-2611
US

V. Phone/Fax

Practice location:
  • Phone: 720-943-7080
  • Fax: 720-316-7577
Mailing address:
  • Phone: 407-415-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: