MEDICARE: CARLEY THAW

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	0018358	CO

General Provider Information

NPI Number	:	1578137741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY THAW

Provider Business Mailing Address
First Line	:	1490 N LAFAYETTE ST STE 108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 N LAFAYETTE ST STE 108
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2391
Country	:	US
Telephone Number	:	303-954-4052
Fax Number	:

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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Directions to “ CARLEY THAW ” Practice Location

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