Provider Demographics
NPI:1255710414
Name:MALLORY GOLLICK, LPC
Entity type:Organization
Organization Name:MALLORY GOLLICK, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:303-520-8096
Mailing Address - Street 1:609 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2699
Practice Address - Country:US
Practice Address - Phone:303-520-8096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty