Individual
MRS. MARY LOUISE FANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM&FT
Contact information
Practice address
15798 E. PRENTICE DR., CENTENNIAL, TX 80015-4268
(303) 901-3313
Mailing address
15798 E. PRENTICE DR., CENTENNIAL, TX 80015-4268
(303) 901-3313
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
927
CO
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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