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General NPI Number Information
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NPI Number | 1831636018
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Entity Type | Organization
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Legal Business Name | MARY K. HOWARD
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1190 S LASHLEY LN
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City | BOULDER
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State | CO
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Zip | 80305-6709
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Country | US
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Telephone | 303-590-5766
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 S LASHLEY LN
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City | BOULDER
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State | CO
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Zip | 80305-6709
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Country | US
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Telephone | 303-590-5766
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. MARY K. HOWARD
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Credential | MA LPC
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Telephone | 303-590-5766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LPC.0012054
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License Number State | CO
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