MEDICARE: MRS. VANESSA GRACE FAGNANT LPC

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	LPC.0022375	CO

General Provider Information

NPI Number	:	1205686391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA GRACE FAGNANT LPC

Provider Business Mailing Address
First Line	:	4825 COLLINSVILLE PL
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-6824
Country	:	US
Telephone Number	:	720-934-3939
Fax Number	:	720-991-1349

Provider Business Practice Location Address
First Line	:	5921 MIDDLEFIELD RD STE 203
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2860
Country	:	US
Telephone Number	:	720-770-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/13/2026

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