Individual provider Active NPI

Jesse Liu, LCSW

  • Clinical Social Worker
  • Fort Collins, CO
National Provider Identifier
1558143602
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
2919 Alamo Ave
Fort Collins, CO 80525-2503
Phone
(970) 658-0024
NPI assigned
Oct 13, 2023
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X .09929578 CO
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

2919 Alamo Ave
Fort Collins, CO 80525-2503

Mailing address

PO Box 270326
Fort Collins, CO 80527-0326

Other practice location 1

4601 Corbett Dr
Fort Collins, CO 80528-9579
Phone (970) 207-4857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250108002726 CO Practitioner - Clinical Social Worker 4880122563 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
.09929578COMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Sep 29, 2025 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 29, 2025 Accepting new patients
NPI 1457494304 CurrentSince Nov 4, 2024 Accepting new patients
Empathic Insights, LLC Mental Health CurrentSince Oct 1, 2023 Accepting new patients
Poudre Valley Health Care Inc. Current Accepting new patients
Poudre Valley Health Care Inc CurrentSince Nov 4, 2024 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

1025 Pennock Pl
Fort Collins, CO 80524
Phone (970) 495-8800

1107 S Lemay Ave
Ste 100
Fort Collins, CO 80524
Phone (970) 207-4857

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1558143602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270326",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805270326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 ALAMO AVE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805252503",
            "telephone_number": "970-658-0024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4601 Corbett Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805289579",
            "country_code": "US",
            "telephone_number": "970-207-4857",
            "fax_number": "970-207-4885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "JESSE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-13",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": ".09929578",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.