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General NPI Number Information
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NPI Number | 1922826973
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Entity Type | Organization
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Legal Business Name | AUTHENTIC CONNECTIONS THERAPY AND WELLNESS
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 2460 W 26TH AVE STE 450C
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City | DENVER
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State | CO
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Zip | 80211-5315
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Country | US
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Telephone | 720-386-4046
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 W 26TH AVE STE 450C
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City | DENVER
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State | CO
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Zip | 80211-5315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MALLAREE BLAKE
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Credential | PSYD
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Telephone | 720-964-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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