Healthcare Provider Details

I. General information

NPI: 1245758911
Provider Name (Legal Business Name): LAUREL ANN MARCO M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST STE 200
WHEAT RIDGE CO
80033-6712
US

IV. Provider business mailing address

4851 INDEPENDENCE ST STE 200
WHEAT RIDGE CO
80033-6712
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-0300
  • Fax: 303-432-5071
Mailing address:
  • Phone: 303-425-0300
  • Fax: 303-432-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: