Provider Demographics
NPI:1144700873
Name:SERRA, MEAD (LMFT)
Entity type:Individual
Prefix:MR
First Name:MEAD
Middle Name:
Last Name:SERRA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 28 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4962
Mailing Address - Country:US
Mailing Address - Phone:970-852-1837
Mailing Address - Fax:
Practice Address - Street 1:217 N SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5806
Practice Address - Country:US
Practice Address - Phone:970-417-8187
Practice Address - Fax:970-683-7277
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0002578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist