Provider Demographics
NPI:1912556242
Name:PAULSEN, MCKENNA (MA, LPCC, LMHCA)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MA, LPCC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E SPEER BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3719
Mailing Address - Country:US
Mailing Address - Phone:970-281-7310
Mailing Address - Fax:
Practice Address - Street 1:825 E SPEER BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3719
Practice Address - Country:US
Practice Address - Phone:970-281-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016943101YM0800X
WAMC60972963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health