Active NPI
Unknown Phoenix, LPC, CACIII
- Professional Counselor
- Fort Collins, CO
National Provider Identifier
1750672937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3067
- Practice address
- 1220 S College Ave
Fort Collins, CO 80524-3716 - Phone
- (970) 402-8543
- Fax
- (970) 493-9113
- NPI assigned
- Apr 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5254 | CO | |
| Professional Counselor | 101YP2500X | 3067 | CO | Primary |
Addresses
Primary practice location
1220 S College Ave
Fort Collins, CO 80524-3716
Mailing address
1220 S College Ave
Fort Collins, CO 80524-3716
Phone (970) 402-8543
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 |
|---|---|---|---|
| 5254 | CO | MD | Addiction (Substance Use Disorder) Counselor |
| 3067 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303430400000",
"number": "1750672937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 S COLLEGE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805243716",
"telephone_number": "970-402-8543",
"fax_number": "970-493-9113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 S COLLEGE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805243716",
"telephone_number": "970-402-8543",
"fax_number": "970-493-9113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOENIX",
"first_name": "UNKNOWN",
"credential": "LPC, CACIII",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-22",
"last_updated": "2011-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "5254",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "3067",
"primary": true
}
],
"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 Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.