Provider Demographics
NPI:1558523704
Name:MCKERNAN, COLLEEN ANN (MFT, LAC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:MFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 LAFAYETTE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:720-810-5922
Mailing Address - Fax:720-941-4066
Practice Address - Street 1:1490 LAFAYETTE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218
Practice Address - Country:US
Practice Address - Phone:720-810-5922
Practice Address - Fax:720-941-4066
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6534101YA0400X
CO825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist