Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor |
NPI | 1003445552 |
---|---|
Provider Name | Jenni Mcdade |
First Address | Lyons, CO 80540-8833 |
Second Address | Longmont, CO 80503-6424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2020 |
Last Update Date | 07/04/2020 |