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General NPI Number Information
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NPI Number | 1437607157
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Entity Type | Organization
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Legal Business Name | MIND BODY WELLNESS COUNSELING
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 2821 S PARKER RD STE 405
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City | AURORA
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State | CO
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Zip | 80014-2748
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Country | US
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Telephone | 720-372-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 S CHERRY ST APT 5-205
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City | DENVER
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State | CO
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Zip | 80246-3138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA MARCONI
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Credential | LCSW
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Telephone | 720-883-4842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09923849
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License Number State | CO
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