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NPI Code Detail

MEDICARE: CANDICE MASHBURN BARDALES LCSW, LAC

MEDICARE: CANDICE MASHBURN BARDALES LCSW, LAC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACD.0002645CO
21041C0700XClinical Social WorkerCSW.09928944CO

General Provider Information

NPI Number : 1508571944
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE MASHBURN BARDALES LCSW, LAC
Provider Business Mailing Address
First Line : 743 HORIZON CT STE 220
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-8716
Country : US
Telephone Number : 970-310-3406
Fax Number :
Provider Business Practice Location Address
First Line : 743 HORIZON CT STE 220
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-8716
Country : US
Telephone Number : 970-310-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2023
Last Update Date : 02/06/2026

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