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General NPI Number Information
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NPI Number | 1467653477
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Entity Type | Individual
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Provider Name | KELLY MARIE MEAD LPC
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 2880 W HOLDEN PL
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City | DENVER
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State | CO
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Zip | 80204-3353
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Country | US
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Telephone | 720-612-7134
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Fax |
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Provider Business Mailing Address
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Address Line | 2880 W HOLDEN PL
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City | DENVER
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State | CO
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Zip | 80204-3353
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Country | US
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Telephone | 303-953-6600
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8933A
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | LPP.0001308
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0011766
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License Number State | CO
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