Healthcare Provider Details

I. General information

NPI: 1851015747
Provider Name (Legal Business Name): FRESH START COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 YALE PL
CANON CITY CO
81212-4611
US

IV. Provider business mailing address

47 OAK LEAF CT
CANON CITY CO
81212-4264
US

V. Phone/Fax

Practice location:
  • Phone: 719-371-0851
  • Fax:
Mailing address:
  • Phone: 719-371-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA WATLEY
Title or Position: OWNER
Credential: LPC, LAC
Phone: 719-371-0851