MEDICARE: HAYDEN CAHILL BLANK

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

General Provider Information

NPI Number	:	1750800090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYDEN CAHILL BLANK

Provider Business Mailing Address
First Line	:	2450 S VINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5264
Country	:	US
Telephone Number	:	303-871-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 S VINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5209
Country	:	US
Telephone Number	:	303-871-3626
Fax Number	:

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

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

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Directions to “ HAYDEN CAHILL BLANK ” Practice Location

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