Provider Demographics
NPI:1053505925
Name:CONDON, MARK JOHN (LPC,)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHN
Last Name:CONDON
Suffix:
Gender:M
Credentials:LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 E HAMPDEN AVE APT 711
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4882
Mailing Address - Country:US
Mailing Address - Phone:303-751-5177
Mailing Address - Fax:303-751-5177
Practice Address - Street 1:8525 E HAMPDEN AVE APT 711
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4882
Practice Address - Country:US
Practice Address - Phone:303-751-5177
Practice Address - Fax:303-751-5177
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3823101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor