MEDICARE: EMERGE THERAPY LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104689660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGE THERAPY LLC

Provider Business Mailing Address
First Line	:	2519 S SHIELDS ST
Second Line	:	SUITE 1K PMB 1065
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1855
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2572
Country	:	US
Telephone Number	:	607-346-1983
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DEVAN PAUL LIVAUDAIS
Credential	:	LPC, NCC
Telephone Number	:	607-346-1983

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	03/03/2026

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