MEDICARE: HIRAM EMORY WIDENER III LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPCC.0017045	CO

General Provider Information

NPI Number	:	1164010518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIRAM EMORY WIDENER III LPCC

Provider Business Mailing Address
First Line	:	PO BOX 3032
Second Line	:
City	:	SILVERTHORNE
State	:	CO
Zip	:	80498-3032
Country	:	US
Telephone Number	:	303-515-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S WADSWORTH BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80227-3414
Country	:	US
Telephone Number	:	303-578-9434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	12/31/2020

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