MEDICARE: MARK O'LAUGHLIN MA, 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	4090	CO
2	101YP2500X	Professional Counselor	4090	CO

General Provider Information

NPI Number	:	1508163932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK O'LAUGHLIN MA, LPC

Provider Business Mailing Address
First Line	:	4851 INDEPENDENCE ST
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6715
Country	:	US
Telephone Number	:	413-281-3584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 COLORADO BLVD
Second Line	:	CLEAR CREEK COMMUNITY CENTER
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-3959
Country	:	US
Telephone Number	:	413-281-3584
Fax Number	:

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	12/05/2011

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