Provider Demographics
NPI:1578977153
Name:STANLEY, MARIANN (LPC, CAC III)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1824
Mailing Address - Country:US
Mailing Address - Phone:303-441-1463
Mailing Address - Fax:
Practice Address - Street 1:3470 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1824
Practice Address - Country:US
Practice Address - Phone:303-441-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3942101YP2500X
CO3211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)