Provider Demographics
NPI:1861137994
Name:KELLY, CAREN L (MFTC)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:L
Last Name:KELLY
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:CAREN
Other - Middle Name:L
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 BOWIE DR UNIT 1107
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-8357
Mailing Address - Country:US
Mailing Address - Phone:303-396-9271
Mailing Address - Fax:
Practice Address - Street 1:8471 TURNPIKE DR STE 250
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7048
Practice Address - Country:US
Practice Address - Phone:720-425-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist