Provider Demographics
NPI:1306433933
Name:SCHALL, MARK JAY (LPCC, CAT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAY
Last Name:SCHALL
Suffix:
Gender:M
Credentials:LPCC, CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 E TENNESSEE AVE APT 123
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1624
Mailing Address - Country:US
Mailing Address - Phone:720-580-2364
Mailing Address - Fax:
Practice Address - Street 1:6800 E TENNESSEE AVE APT 123
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1624
Practice Address - Country:US
Practice Address - Phone:720-580-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health