NPIMap

Organization Active NPI

Psychedin

  • Professional Counselor
  • Aurora, CO
National Provider Identifier
1124489927
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
1686 Issued in CO
Legal business name
PSYCHEDIN
Practice address
2101 S Blackhawk St
Suite 180
Aurora, CO 80014-1492
Phone
(303) 380-1858
NPI assigned
Mar 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen Elizabeth Anderson Fagan, MA, LPCNPI 1407078728
Title
Owner
Phone
(303) 380-1858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 1686 CO Primary

Addresses

Primary practice location

2101 S Blackhawk St
Suite 180
Aurora, CO 80014-1492

Mailing address

PO Box 59
Strasburg, CO 80136-0059
Phone (303) 380-1858

Other practice location 1

1506 Main St.
Strasburg, CO 80136
Phone (303) 380-1858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241218004029 CO Part B Supplier - Clinic/Group Practice 2365979044 Receives reassigned benefits from 1 practitioner
Practice locations: Strasburg, CO

National Provider Directory

National Provider Directory

Locations

2101 S Blackhawk St
Ste 180
Aurora, CO 80014
Phone (303) 380-1858

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1124489927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59",
            "city": "STRASBURG",
            "state": "CO",
            "postal_code": "801360059",
            "telephone_number": "303-380-1858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 S BLACKHAWK ST",
            "address_2": "SUITE 180",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800141492",
            "telephone_number": "303-380-1858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1506 Main St.",
            "address_purpose": "LOCATION",
            "city": "Strasburg",
            "state": "CO",
            "postal_code": "80136",
            "country_code": "US",
            "telephone_number": "303-380-1858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHEDIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSON FAGAN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-380-1858",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "1686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.