MEDICARE: MS. KELLY MCGRAIL CURRAN BENNETT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001194	CO
2	106H00000X	Marriage & Family Therapist
3	101YP2500X	Professional Counselor	LPC.0015294	CO

General Provider Information

NPI Number	:	1407176415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY MCGRAIL CURRAN BENNETT

Provider Business Mailing Address
First Line	:	3680 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3109
Country	:	US
Telephone Number	:	303-349-0752
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3109
Country	:	US
Telephone Number	:	303-349-0752
Fax Number	:

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	08/24/2021

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