Provider Demographics
NPI:1518576040
Name:MADER, CAROLYN MAE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAE
Last Name:MADER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 BAYFRONT CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3592
Mailing Address - Country:US
Mailing Address - Phone:970-443-3010
Mailing Address - Fax:
Practice Address - Street 1:2025 BAYFRONT CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3592
Practice Address - Country:US
Practice Address - Phone:970-443-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional