Provider Demographics
NPI:1568849297
Name:TEEL, MARILYNN K (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:K
Last Name:TEEL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:M.
Other - Middle Name:KAY
Other - Last Name:TEEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1320 STUART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1243
Mailing Address - Country:US
Mailing Address - Phone:720-472-2832
Mailing Address - Fax:
Practice Address - Street 1:1320 STUART ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1243
Practice Address - Country:US
Practice Address - Phone:720-472-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW 009915161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17602343Medicaid