Provider Demographics
NPI:1205521663
Name:PRANGE, MARK EDWARD (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:PRANGE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-4527
Mailing Address - Country:US
Mailing Address - Phone:970-443-9886
Mailing Address - Fax:
Practice Address - Street 1:777 S WADSWORTH BLVD
Practice Address - Street 2:BUILDING 1, SUITE 202
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:970-795-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health