MEDICARE: LAUREL TREE COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104680909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL TREE COUNSELING

Provider Business Mailing Address
First Line	:	5120 STETSON CREEK CT UNIT C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3005
Country	:	US
Telephone Number	:	970-316-2298
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 STETSON CREEK CT UNIT C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3005
Country	:	US
Telephone Number	:	970-316-2298
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	ZEHNEP DEFNE WEAVER
Credential	:	LCSW
Telephone Number	:	970-215-6217

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/28/2025

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