Lissette D Frederick, LPC
Individual provider Active NPI Professional Counselor · Frederick, CO
NPI 1316712151 · NPPES record last updated Nov 21, 2023
Key facts
- NPI
- 1316712151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC.0019840 (CO)
- Practice address
- 5995 Iris Pkwy
Frederick, CO 80504-6412 - Phone
- (303) 697-2583
- Fax
- (303) 833-6515
- NPI assigned
- Nov 21, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231202000411 | CO | Practitioner - Mental Health Counselor | 2961850805 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC.0019840 | CO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salud Family Health | Current |
Accepting new patients | |
| Salud Family Health | Current | Accepting new patients | |
| Salud Family Health | Current |
Accepting new patients | |
| Salud Family Health | Past | Accepting new patients |
Locations
203 S Rollie Ave
Fort Lupton, CO 80621
Phone (303) 286-4560
5995 Iris Pkwy
Frederick, CO 80504
Phone (303) 833-2050
220 E Rogers Rd
Longmont, CO 80501
Phone (303) 776-3250
Interoperability endpoints
- lissette.frederick@sfhc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC.0019840 | CO | Yes |
Addresses
Primary practice location
5995 Iris Pkwy
Frederick, CO 80504-6412
Mailing address
203 S Rollie Ave
Fort Lupton, CO 80621-1508
Phone (303) 892-6401
Other providers in Frederick, CO
- Lawrence M Feinman
- Firestone Pediatric Dentistry and Orthodontics
- David Fisk
- Michelle Lynn Fray
- Frederick Area Fire Protection District
- Stephanie Jean Freise
- Elizabeth Frias
- Froc, PC
- Amy Lynn Galvan
- Garlock Firestone Orthodontics LLC
All providers in Frederick, CO · Professional Counselor in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.