MEDICARE: INTEGRATED COUNSELING AND WELLNESS

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
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568921120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED COUNSELING AND WELLNESS

Provider Business Mailing Address
First Line	:	2627 REDWING RD STE 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6310
Country	:	US
Telephone Number	:	970-430-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 REDWING RD STE 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6310
Country	:	US
Telephone Number	:	970-430-6061
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ALYSSA WRIGHT
Credential	:	LCSW
Telephone Number	:	970-430-6061

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	11/22/2021

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Directions to “INTEGRATED COUNSELING AND WELLNESS ” Practice Location

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