Provider Demographics
NPI:1083934863
Name:MABIS, JOANNE M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:MABIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:M
Other - Last Name:ENTJER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4755 S XENON WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-1768
Mailing Address - Country:US
Mailing Address - Phone:719-205-4543
Mailing Address - Fax:719-205-4543
Practice Address - Street 1:4755 S XENON WAY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-1768
Practice Address - Country:US
Practice Address - Phone:719-205-4543
Practice Address - Fax:719-205-4543
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5952101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health