Provider Demographics
NPI:1154470730
Name:KLARENBEEK-MCKENNA, MISTI ANNE (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:ANNE
Last Name:KLARENBEEK-MCKENNA
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 W 41ST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4565
Mailing Address - Country:US
Mailing Address - Phone:303-503-5295
Mailing Address - Fax:303-432-2297
Practice Address - Street 1:7651 W 41ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4565
Practice Address - Country:US
Practice Address - Phone:303-503-5295
Practice Address - Fax:303-432-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929931041C0700X
CO775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist