NPIMap

Organization Active NPI

Neurofeedback Clinic of Northern Colorado LLC

  • Clinical Social Worker
  • Fort Collins, CO
National Provider Identifier
1659794477
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9923938 Issued in CO
Legal business name
NEUROFEEDBACK CLINIC OF NORTHERN COLORADO LLC
Practice address
4115 Boardwalk Drive, Suite 100
Fort Collins, CO 80525-5945
Phone
(970) 493-4580
Fax
(970) 797-2859
NPI assigned
Jan 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Authorized official

Name
Lisa Pendleton, LMFTNPI 1548591878
Title
Clinical Director
Phone
(970) 493-4580

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 12332 CO
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 9923938 CO Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 974 CO
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 983 CO

Addresses

Primary practice location

4115 Boardwalk Drive, Suite 100
Fort Collins, CO 80525-5945

Mailing address

4115 Boardwalk Dr
Suite 100
Fort Collins, CO 80525-5945
Phone (970) 493-4580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150909000093 CO Part B Supplier - Clinic/Group Practice 6406162353 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Fort Collins, CO; Greeley, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Neurofeedback Clinic of Northern Colorado LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4115 Boardwalk Dr
Unit 100
Fort Collins, CO 80525
Phone (970) 493-4580

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1659794477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DR",
            "address_2": "SUITE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255945",
            "telephone_number": "970-493-4580",
            "fax_number": "970-797-2859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 BOARDWALK DRIVE, SUITE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255945",
            "telephone_number": "970-493-4580",
            "fax_number": "970-797-2859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROFEEDBACK CLINIC OF NORTHERN COLORADO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "PENDLETON",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "970-493-4580",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "12332",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "9923938",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "974",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "983",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; 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.