Healthcare Provider Details

I. General information

NPI: 1063321206
Provider Name (Legal Business Name): MARY ELIZABETH AVANT MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 DOMINION WAY STE 202
COLORADO SPRINGS CO
80918-8473
US

IV. Provider business mailing address

5628 SPOKED WHEEL DR
COLORADO SPRINGS CO
80923-8726
US

V. Phone/Fax

Practice location:
  • Phone: 719-419-3939
  • Fax:
Mailing address:
  • Phone: 830-499-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0025347
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: