Healthcare Provider Details

I. General information

NPI: 1396374310
Provider Name (Legal Business Name): THE MARRIAGE AND FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 PECOS ST STE 170
WESTMINSTER CO
80234-2015
US

IV. Provider business mailing address

12050 PECOS ST STE 170
WESTMINSTER CO
80234-2015
US

V. Phone/Fax

Practice location:
  • Phone: 720-648-8285
  • Fax: 720-808-1594
Mailing address:
  • Phone: 720-648-8285
  • Fax: 720-808-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BECKY ANDERSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 720-648-8285