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General NPI Number Information
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NPI Number | 1457453268
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Entity Type | Organization
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Legal Business Name | MAROLD MINDSET INC.
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 2864 S CIRCLE DR STE 350
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4114
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Country | US
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Telephone | 719-531-9211
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Fax | 719-540-6045
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Provider Business Mailing Address
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Address Line | 3120 BRADY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-2125
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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 | MARION MAROLD VICKERMAN
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Credential | LMFT
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Telephone | 719-660-4039
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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 | 613
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License Number State | CO
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