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General NPI Number Information
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NPI Number | 1023455268
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Entity Type | Individual
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Provider Name | MARY ANN FORREIDER MA, LAC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 12/27/2025
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Provider Practice Location Address
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Address Line | 420 21ST AVE STE 113
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City | LONGMONT
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State | CO
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Zip | 80501-1441
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Country | US
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Telephone | 303-834-9369
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Fax | 303-834-9396
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Provider Business Mailing Address
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Address Line | 1751 HOVER ST
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City | LONGMONT
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State | CO
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Zip | 80501-7181
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Country | US
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Telephone | 303-834-9369
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Fax | 303-834-9396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0000339
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT.0001573
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License Number State | CO
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