Revision Counseling

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REVISION COUNSELING

Practice address

2625 Redwing Rd
Fort Collins, CO 80526-6313

Phone

(405) 410-6378

NPI assigned

Oct 24, 2018

Organization subpart

No

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

Authorized official

Name

Jolie B Boudreaux, MA, LPCNPI 1659678589

Title

Owner

Phone

(405) 410-6378

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jolie Beth Boudreaux, L.P.C

  • Professional Counselor
  • Fort Collins, CO
  • NPI 1659678589
  NPD Authorized official

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1891262200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 GOLDEN HARVEST LN",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283137",
            "telephone_number": "405-410-6378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 REDWING RD",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266313",
            "telephone_number": "405-410-6378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVISION COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "JOLIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-410-6378",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "67175031",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Restore Grace Counseling LLC
• Diana Retherford, BS
• Katrina Reti, M.S.
• Meghan Reusser, NP
• Revelation Chiropractic LLC
• Revive LLC
• Eric Rewerts, PHARMD.
• Reyes Corporation
• Stephanie Reyes, MAC, LPC, LAC, ACS
• Victoria Reyes

• Mental Health Counselor in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.