NPIMap

Individual provider Active NPI

Joy E Dejong Lago, PHD

  • Clinical Psychologist
  • Fort Collins, CO
National Provider Identifier
1699902668
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0003795 Issued in CO
Practice address
2315 E Harmony Rd
Suite 110
Fort Collins, CO 80528-8620
Phone
(970) 482-4373
Fax
(970) 484-5682
NPI assigned
Jun 17, 2009
Last updated
Apr 13, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301013636 MI
Clinical Psychologist 103TC0700X 0003795 CO Primary

Addresses

Primary practice location

2315 E Harmony Rd
Suite 110
Fort Collins, CO 80528-8620

Mailing address

2315 E Harmony Rd
Suite 110
Fort Collins, CO 80528-8620
Phone (970) 482-4373

Other identifiers 1

IdentifierTypeStateIssuer
97183229MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130225000282 CO Practitioner - Clinical Psychologist 8527105121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

2315 E Harmony Rd
Suite 110 Uchmg Neurology Redstone
Fort Collins, CO 80528-8623
Phone (970) 482-4373

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0003795COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Mar 2, 2015 Accepting new patients

Locations

4110 Briargate Pkwy
Ste 140
Colorado Springs, CO 80920
Phone (719) 365-7300

2315 E Harmony Rd
Ste 110
Fort Collins, CO 80528
Phone (970) 212-7600

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

2695 Rocky Mountain Ave
Ste 200
Loveland, CO 80538
Phone (970) 495-8490

Organizations & group practices 2

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1699902668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 E HARMONY RD",
            "address_2": "SUITE 110",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288620",
            "telephone_number": "970-482-4373",
            "fax_number": "970-484-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 E HARMONY RD",
            "address_2": "SUITE 110",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288620",
            "telephone_number": "970-482-4373",
            "fax_number": "970-484-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG LAGO",
        "first_name": "JOY",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-17",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013636",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "0003795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97183229",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.