MEDICARE: COUNSELING PARTNERS OF NORTHERN COLORADO, PLLC

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	12830	CO
2	101YP2500X	Professional Counselor	13780	CO

General Provider Information

NPI Number	:	1306186721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING PARTNERS OF NORTHERN COLORADO, PLLC

Provider Business Mailing Address
First Line	:	8010 S COUNTY ROAD 5 UNIT 201
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9004
Country	:	US
Telephone Number	:	970-481-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 S COUNTY ROAD 5 UNIT 201
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9004
Country	:	US
Telephone Number	:	970-481-9830
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED PSYCHOTHERAPIST #13780
Name	:	LILY MAINO
Credential	:	M.S.
Telephone Number	:	980-481-9830

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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