=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669856787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA MARLENE MULVANY LPC, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2015
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6404 S QUEBEC ST BLDG 1
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-263-1088
-----------------------------------------------------
Fax | 303-963-5356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6404 S QUEBEC ST BLDG 1
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-4628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-981-2730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LPCC.0014073
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------