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1221 E Elizabeth St Ste 3 Fort Collins CO 80524-4066 | |
| (970) 682-1337 | |
| (855) 461-3393 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1221 E Elizabeth St Ste 3, Fort Collins, Colorado |
| Authorized Official Name and Position | Lauren Stanley (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9706821337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1221 E Elizabeth St Ste 3 Fort Collins CO 80524-4066 Ph: (970) 682-1337 | 1221 E Elizabeth St Ste 3 Fort Collins CO 80524-4066 Ph: (970) 682-1337 |
| NPI Number | 1407429350 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 12/20/2023 |
| Certification Date | 12/20/2023 |
| Medicare PECOS PAC ID | 4789089335 |
|---|---|
| Medicare Enrollment ID | O20210820000750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407429350 | NPI | - | NPPES |
| 9000195595 | Medicaid | CO |
| Provider Name | Lauren Boe Stanley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184972291 PECOS PAC ID: 0840504056 Enrollment ID: I20160331000688 |
| Provider Name | Charlotte Stephens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386407534 PECOS PAC ID: 1355886813 Enrollment ID: I20240709004395 |
| Provider Name | Stephanie Kiehl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174371934 PECOS PAC ID: 7517402985 Enrollment ID: I20240709004862 |
| Provider Name | Erin Canon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942067897 PECOS PAC ID: 8325585409 Enrollment ID: I20240807001455 |
| Provider Name | Carter Glenn Holmes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679319099 PECOS PAC ID: 4284174004 Enrollment ID: I20240909000068 |
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