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General NPI Number Information
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NPI Number | 1801407382
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Entity Type | Individual
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Provider Name | MARY EMMA FAWCETT MFTC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 12303 AIRPORT WAY STE 125
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City | BROOMFIELD
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State | CO
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Zip | 80021-2729
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Country | US
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Telephone | 970-310-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 TENNYSON ST
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City | DENVER
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State | CO
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Zip | 80212-3029
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Country | US
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Telephone | 303-433-2541
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCC.0017575
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFTC.0014311
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License Number State | CO
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