=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639183346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY PATRICIA KARDOS MA, CACIII
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 01/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4141 E DICKENSON PL
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-504-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26165 STANSBERRY ST
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-809-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 6300
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 5048
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------