Healthcare Provider Details

I. General information

NPI: 1285565689
Provider Name (Legal Business Name): MANDY KIEBLER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 S JULIAN ST
LITTLETON CO
80123-2881
US

IV. Provider business mailing address

5710 S JULIAN ST
LITTLETON CO
80123-2881
US

V. Phone/Fax

Practice location:
  • Phone: 720-670-9872
  • Fax:
Mailing address:
  • Phone: 720-670-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002978
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: