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NPI Code Detail

MEDICARE: KELLY MARIE MEAD LPC

MEDICARE: KELLY MARIE MEAD 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 Counselor8933ANC
2322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityLPP.0001308CO
3101YP2500XProfessional CounselorLPC.0011766CO

General Provider Information

NPI Number : 1467653477
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE MEAD LPC
Provider Business Mailing Address
First Line : 2880 W HOLDEN PL
Second Line :
City : DENVER
State : CO
Zip : 80204-3353
Country : US
Telephone Number : 303-953-6600
Fax Number :
Provider Business Practice Location Address
First Line : 2880 W HOLDEN PL
Second Line :
City : DENVER
State : CO
Zip : 80204-3353
Country : US
Telephone Number : 720-612-7134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 02/28/2024

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