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General NPI Number Information
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NPI Number | 1740918077
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Entity Type | Individual
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Provider Name | MARLYS HERSEY LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2022
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 4 PRINCESS ANN PL
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City | ALAMOSA
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State | CO
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Zip | 81101-3351
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Country | US
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Telephone | 302-915-0493
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Fax |
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Provider Business Mailing Address
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Address Line | 4 PRINCESS ANN PL
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City | ALAMOSA
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State | CO
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Zip | 81101-3351
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Country | US
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Telephone | 432-386-0479
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC.0019754
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0002359
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License Number State | CO
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