Provider Demographics
NPI:1447073879
Name:WILLARD, MARCY (PHD)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:LEFFINGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6829 S BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4334
Mailing Address - Country:US
Mailing Address - Phone:303-618-9801
Mailing Address - Fax:
Practice Address - Street 1:11001 W 120TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3493
Practice Address - Country:US
Practice Address - Phone:303-222-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical