Healthcare Provider Details

I. General information

NPI: 1558266791
Provider Name (Legal Business Name): CHARLOTTE EMILY PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MELODY DR STE 318
NORTHGLENN CO
80234-4122
US

IV. Provider business mailing address

360 ACOMA ST UNIT 348
DENVER CO
80223-1153
US

V. Phone/Fax

Practice location:
  • Phone: 720-520-7755
  • Fax:
Mailing address:
  • Phone: 443-534-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: