Active NPI
Mario Carrillo, LPC
- Professional Counselor
- Longmont, CO
National Provider Identifier
1407511314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC.0017496
- Practice address
- 1925 Mountain View Ave
Longmont, CO 80501-3128 - Phone
- (720) 494-3121
- Fax
- (720) 494-3108
- NPI assigned
- Nov 4, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC.0017496 | CO | Primary |
Addresses
Primary practice location
1925 Mountain View Ave
Longmont, CO 80501-3128
Mailing address
1925 Mountain View Ave
Longmont, CO 80501-3128
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC.0017496 | CO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635984000000",
"number": "1407511314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 MOUNTAIN VIEW AVE",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805013128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 MOUNTAIN VIEW AVE",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805013128",
"telephone_number": "720-494-3121",
"fax_number": "720-494-3108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "MARIO",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-04",
"last_updated": "2021-11-04",
"certification_date": "2021-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "LPC.0017496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.