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General NPI Number Information
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NPI Number | 1144700873
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Entity Type | Individual
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Provider Name | MEAD SERRA LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 217 N SAN JUAN AVE
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City | MONTROSE
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State | CO
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Zip | 81401-5806
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Country | US
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Telephone | 970-417-8187
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Fax | 970-683-7277
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Provider Business Mailing Address
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Address Line | 515 28 1/2 RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-4962
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Country | US
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Telephone | 970-852-1837
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | .0002578
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License Number State | CO
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