Healthcare Provider Details

I. General information

NPI: 1417428327
Provider Name (Legal Business Name): PAUL W COLLOP LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10497 JELLISON WAY
BROOMFIELD CO
80021-3675
US

IV. Provider business mailing address

13585 JACKSON ST
THORNTON CO
80241-1419
US

V. Phone/Fax

Practice location:
  • Phone: 253-880-5103
  • Fax:
Mailing address:
  • Phone: 253-880-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA.0008337
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024014
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: