Provider Demographics
NPI:1326620170
Name:WENTZEL, MARY KATHLEEN (LPCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MAC
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3101 SOPRIS AVE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4440
Mailing Address - Country:US
Mailing Address - Phone:970-379-1588
Mailing Address - Fax:
Practice Address - Street 1:812 GRAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3478
Practice Address - Country:US
Practice Address - Phone:970-379-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional