Provider Demographics
NPI:1962466821
Name:STOHL, KELLY TODD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:TODD
Last Name:STOHL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3263 FRASER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1245
Mailing Address - Country:US
Mailing Address - Phone:303-371-1000
Mailing Address - Fax:303-371-1002
Practice Address - Street 1:3263 FRASER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1217
Practice Address - Country:US
Practice Address - Phone:303-371-1000
Practice Address - Fax:303-371-1002
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical