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General NPI Number Information
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NPI Number | 1447073879
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Entity Type | Individual
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Provider Name | MARCY WILLARD PHD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 11001 W 120TH AVE STE 400
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City | BROOMFIELD
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State | CO
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Zip | 80021-3493
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Country | US
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Telephone | 303-222-7923
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Fax |
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Provider Business Mailing Address
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Address Line | 6829 S BOULDER RD
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City | BOULDER
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State | CO
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Zip | 80303-4334
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Country | US
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Telephone | 303-618-9801
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4389
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License Number State | CO
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