Healthcare Provider Details

I. General information

NPI: 1003587825
Provider Name (Legal Business Name): DAWN MOCKLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VESTA RD
SALIDA CO
81201-9327
US

IV. Provider business mailing address

111 VESTA RD
SALIDA CO
81201-9327
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-6502
  • Fax: 719-539-3988
Mailing address:
  • Phone: 719-539-6502
  • Fax: 719-539-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number107558
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: