MEDICARE: HAILEY KEEGAN SANDS

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	101YP2500X	Professional Counselor	LPC.0015847	CO

General Provider Information

NPI Number	:	1659087195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY KEEGAN SANDS

Provider Business Mailing Address
First Line	:	12954 W ILIFF AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-4336
Country	:	US
Telephone Number	:	303-954-4052
Fax Number	:	303-399-8010

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	:	303-399-8010

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

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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Directions to “ HAILEY KEEGAN SANDS ” Practice Location

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