Provider Demographics
NPI:1790268191
Name:MARIAN SALLEY LCSW LLC
Entity Type:Organization
Organization Name:MARIAN SALLEY LCSW LLC
Other - Org Name:PHERAL PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LAC CGP ACS
Authorized Official - Phone:303-859-2611
Mailing Address - Street 1:4710 HOLIDAY DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2361
Mailing Address - Country:US
Mailing Address - Phone:303-859-2611
Mailing Address - Fax:
Practice Address - Street 1:2299 PEARL ST STE 400F
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4673
Practice Address - Country:US
Practice Address - Phone:303-859-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty