Provider Demographics
NPI:1912164674
Name:FEHN, MARY PATRICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:PATRICE
Last Name:FEHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819-1007
Mailing Address - Country:US
Mailing Address - Phone:719-684-9511
Mailing Address - Fax:
Practice Address - Street 1:10460 WEST HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:GREEN MOUNTAIN FALLS
Practice Address - State:CO
Practice Address - Zip Code:80819
Practice Address - Country:US
Practice Address - Phone:719-684-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16477286Medicaid