MEDICARE: MEREDITH ELISE KURRY

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	305R00000X	Preferred Provider Organization	992377	CO

General Provider Information

NPI Number	:	1598126120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEREDITH ELISE KURRY

Provider Business Mailing Address
First Line	:	1548 OAK AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-1222
Country	:	US
Telephone Number	:	720-231-7109
Fax Number	:	303-975-4936

Provider Business Practice Location Address
First Line	:	10090 GARRISON ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-3894
Country	:	US
Telephone Number	:	720-231-7109
Fax Number	:	303-975-4936

Authorized Official
Title or Position	:	THERAPIST/MENTAL HEALTH
Name	:	MRS. MEREDITH ELISE KURRY
Credential	:	CSW
Telephone Number	:	720-231-7109

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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