MEDICARE: MS. COLLEEN ANN MCKERNAN MFT, 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6534	CO
2	106H00000X	Marriage & Family Therapist	825	CO

General Provider Information

NPI Number	:	1558523704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN ANN MCKERNAN MFT, LAC

Provider Business Mailing Address
First Line	:	1490 LAFAYETTE ST
Second Line	:	SUITE 208
City	:	DENVER
State	:	CO
Zip	:	80218
Country	:	US
Telephone Number	:	720-810-5922
Fax Number	:	720-941-4066

Provider Business Practice Location Address
First Line	:	1490 LAFAYETTE ST
Second Line	:	SUITE 208
City	:	DENVER
State	:	CO
Zip	:	80218
Country	:	US
Telephone Number	:	720-810-5922
Fax Number	:	720-941-4066

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	10/06/2016

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