MEDICARE: LILY MAINO M.S.

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	13780	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12478	OTHER	CO	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1841322021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY MAINO M.S.

Provider Business Mailing Address
First Line	:	8010 S COUNTY ROAD 5 UNIT 201
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9004
Country	:	US
Telephone Number	:	970-481-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 S COUNTY ROAD 5 UNIT 201
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9004
Country	:	US
Telephone Number	:	970-481-9830
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	06/05/2019

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