Provider Demographics
NPI:1780211177
Name:CAROTHERS, MARY PATRICIA (MFTC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 CAMPUS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6561
Mailing Address - Country:US
Mailing Address - Phone:193-577-5257
Mailing Address - Fax:
Practice Address - Street 1:7045 CAMPUS DR STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-6561
Practice Address - Country:US
Practice Address - Phone:719-357-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT112896106H00000X
AZLAMFT-6360T106H00000X
COMFTC0014137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist