MEDICARE: JOSEPHINE ZORAIDA MARIN MFTC.0013924

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1568014132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE ZORAIDA MARIN MFTC.0013924

Provider Business Mailing Address
First Line	:	4545 WHEATON DR UNIT D280
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7570
Country	:	US
Telephone Number	:	405-464-8164
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 E CRESCENT PKWY STE 603
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2831
Country	:	US
Telephone Number	:	720-370-1800
Fax Number	:

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	07/12/2019

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