Provider Demographics
NPI:1821635202
Name:MAGLEY-HERMAN, MARYANN MARTHA (LPC, LAC, MAC)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:MARTHA
Last Name:MAGLEY-HERMAN
Suffix:
Gender:F
Credentials:LPC, LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12942 CLARKSON CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3979
Mailing Address - Country:US
Mailing Address - Phone:720-323-8128
Mailing Address - Fax:
Practice Address - Street 1:12942 CLARKSON CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3979
Practice Address - Country:US
Practice Address - Phone:720-323-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011769101YM0800X, 103TC1900X
CO260103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)