MEDICARE: CETA MICHAELA MERCADAL LPC

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	101YM0800X	Mental Health Counselor	LPC.0015109	CO

General Provider Information

NPI Number	:	1174058911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CETA MICHAELA MERCADAL LPC

Provider Business Mailing Address
First Line	:	8700 E JEFFERSON AVE
Second Line	:	#370993
City	:	DENVER
State	:	CO
Zip	:	80237-9998
Country	:	US
Telephone Number	:	720-507-8815
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 TEJON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1813
Country	:	US
Telephone Number	:	720-507-8815
Fax Number	:

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	10/05/2022

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