Individual provider Active NPI

Trinda Hosselkus, MA LPC LAC

  • Professional Counselor
  • Canon City, CO
National Provider Identifier
1861911315
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0016022 Issued in CO
Practice address
420 Pike Ave
Canon City, CO 81212-3134
Phone
(719) 371-1435
NPI assigned
Sep 15, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ACD.0001403 CO
Addiction (Substance Use Disorder) Counselor 101YA0400X ACB.0007696 CO
Professional Counselor 101YP2500X LPC.0016022 CO Primary

Addresses

Primary practice location

420 Pike Ave
Canon City, CO 81212-3134

Mailing address

420 Pike Ave
Canon City, CO 81212-3134

Other practice location 1

3239 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-7650

Other identifiers 1

IdentifierTypeStateIssuer
9804MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address skylinecounselingandconsulting@sklcc.org Direct

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
I20240219003515 CO Practitioner - Mental Health Counselor 8123462017 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Self Counseling LLCGroup PAC ID 6901242775, 5 clinicians

Practice addresses (Care Compare)

107 S 9TH St
Suite E
Canon City, CO 81212-3817
Phone (719) 221-0959

831 Royal Gorge Blvd
Suite 222
Canon City, CO 81212-6709
Phone (719) 371-1435

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
ACB.0007696COMDAddiction (Substance Use Disorder) Counselor
ACD.0001403COMDAddiction (Substance Use Disorder) Counselor
LPC.0016022COMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Skyline Counseling and Consulting CurrentSince Sep 18, 2024 Accepting new patients
Sacred Self Counseling, LLC Addiction (Substance Use Disorder) CurrentSince Jun 4, 2024 Accepting new patients
New Frontiers Counseling LLC PastSince Apr 1, 2024 Accepting new patients

Locations

107 S 9th St
Ste E
Canon City, CO 81212
Phone (719) 221-0959

831 Royal Gorge Blvd
Ste 222
Canon City, CO 81212
Phone (719) 371-1435

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1861911315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PIKE AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PIKE AVE",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123134",
            "telephone_number": "719-371-1435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3239 Independence Rd",
            "address_purpose": "LOCATION",
            "city": "Canon City",
            "state": "CO",
            "postal_code": "812129380",
            "country_code": "US",
            "telephone_number": "719-275-7650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOSSELKUS",
        "first_name": "TRINDA",
        "credential": "MA LPC LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-15",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACD.0001403",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACB.0007696",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0016022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9804",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skylinecounselingandconsulting@sklcc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "420 Pike Ave",
            "city": "Canon City",
            "state": "CO",
            "country_code": "US",
            "postal_code": "812123134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

Verify at the official NPI Registry.