MEDICARE: ADRIENNE SARDY M.A.

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.0016562	CO

General Provider Information

NPI Number	:	1407360704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE SARDY M.A.

Provider Business Mailing Address
First Line	:	7825 PINE OAKS LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80926-9776
Country	:	US
Telephone Number	:	505-310-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 LAKEWOOD CIR STE A102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2667
Country	:	US
Telephone Number	:	719-302-3175
Fax Number	:

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

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	10/02/2020

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