Provider Demographics
NPI:1770734089
Name:COONELLY, MARILYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:COONELLY
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 1:100 ARAPAHOE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5862
Mailing Address - Country:US
Mailing Address - Phone:303-938-1870
Mailing Address - Fax:303-413-1203
Practice Address - Street 1:100 ARAPAHOE AVE STE 7
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5862
Practice Address - Country:US
Practice Address - Phone:303-938-1870
Practice Address - Fax:303-413-1203
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health