Stephanie Williams, LPC, LAC

Individual provider Active NPI Professional Counselor · Timnath, CO

NPI 1962830620 · NPPES record last updated Jun 14, 2024

Key facts

NPI
1962830620
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
12397 (CO)
Practice address
4796 Champlain Dr
Timnath, CO 80547-5845
Phone
(720) 645-3373
NPI assigned
Oct 16, 2013
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
742COMDAddiction (Substance Use Disorder) Counselor
12397COMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 12397 CO Yes
Addiction (Substance Use Disorder) Counselor 101YA0400X 742 CO

Addresses

Primary practice location

4796 Champlain Dr
Timnath, CO 80547-5845

Mailing address

4796 Champlain Dr
Timnath, CO 80547-5845
Phone (720) 645-3373

Other names

  • Stephanie Booco Former name

Other providers in Timnath, CO

All providers in Timnath, CO · Professional Counselor in Colorado

Sources for this page

Verify at the official NPI Registry.