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NPI Code Detail

MEDICARE: CASEY SHANK LPC

MEDICARE: CASEY SHANK 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
1101YP2500XProfessional Counselor15880CO

General Provider Information

NPI Number : 1245579580
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY SHANK LPC
Provider Business Mailing Address
First Line : 2892 HAVANA ST
Second Line :
City : DENVER
State : CO
Zip : 80238-3163
Country : US
Telephone Number : 130-380-7267
Fax Number : 303-432-5071
Provider Business Practice Location Address
First Line : 2892 HAVANA ST
Second Line :
City : DENVER
State : CO
Zip : 80238-3163
Country : US
Telephone Number : 970-627-7325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2013
Last Update Date : 07/08/2023

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Directions to “ CASEY SHANK LPC” Practice Location

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