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General NPI Number Information
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NPI Number | 1780956623
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Entity Type | Individual
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Provider Name | KELLYN GLYNN LPC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 106 N FRENCH ST SUITE 201-1
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City | BRECKENRIDGE
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State | CO
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Zip | 80424
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Country | US
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Telephone | 720-722-1242
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 924
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-0924
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Country | US
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Telephone | 720-722-1241
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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 | 6350
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License Number State | CO
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