MEDICARE: MRS. MICHELLE COVENTRY 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	101YP2500X	Professional Counselor	180.015080	IL
2	101YP2500X	Professional Counselor	LPC.0022022	CO

General Provider Information

NPI Number	:	1275113730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE COVENTRY LPC

Provider Business Mailing Address
First Line	:	4730 S COLLEGE AVE STE 204
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 S COLLEGE AVE STE 204
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3763
Country	:	US
Telephone Number	:	970-775-8643
Fax Number	:

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

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	08/05/2025

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