Provider Demographics
NPI:1205104163
Name:ANGELO, MARY ASHLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ASHLEY
Last Name:ANGELO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S DAHLIA CIR
Mailing Address - Street 2:APT. P108
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1357
Mailing Address - Country:US
Mailing Address - Phone:303-720-2674
Mailing Address - Fax:
Practice Address - Street 1:4371 E 72ND AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-1471
Practice Address - Country:US
Practice Address - Phone:303-853-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-3953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health