Provider Demographics
NPI:1467927202
Name:MCDONNELL, MAREN (MS, MFTC)
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:MS, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5277 MANHATTAN CIR STE 250
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-8212
Mailing Address - Country:US
Mailing Address - Phone:303-746-7844
Mailing Address - Fax:
Practice Address - Street 1:5277 MANHATTAN CIR STE 250
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8212
Practice Address - Country:US
Practice Address - Phone:303-746-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist