Provider Demographics
NPI:1457466401
Name:MAH, PETREA ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:PETREA
Middle Name:ANN
Last Name:MAH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 HARLAN ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2924
Mailing Address - Country:US
Mailing Address - Phone:303-430-4010
Mailing Address - Fax:303-430-5306
Practice Address - Street 1:9101 HARLAN ST
Practice Address - Street 2:SUITE 135
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2924
Practice Address - Country:US
Practice Address - Phone:303-430-4010
Practice Address - Fax:303-430-5306
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional