MEDICARE: MR. RYAN NICHOLAS SCARBOROUGH LCSW

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	705	CO

General Provider Information

NPI Number	:	1366635401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN NICHOLAS SCARBOROUGH LCSW

Provider Business Mailing Address
First Line	:	1507 RIVERSIDE AVE.
Second Line	:	SUITE 200
City	:	FT COLLINS
State	:	CO
Zip	:	80524
Country	:	US
Telephone Number	:	970-590-5454
Fax Number	:	970-493-4333

Provider Business Practice Location Address
First Line	:	1507 RIVERSIDE AVE UNIT 200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4383
Country	:	US
Telephone Number	:	970-590-5454
Fax Number	:

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	07/21/2022

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