Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPCC.0015922 | CO |
NPI | 1003352972 |
---|---|
Provider Name | Paige Michal Marvin |
First Address | Collbran, CO 81624-0193 |
Second Address | Collbran, CO 81624-0193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2017 |
Last Update Date | 01/06/2018 |