Healthcare Provider Details

I. General information

NPI: 1124904941
Provider Name (Legal Business Name): AUSTIN C ELIASSON M.S., LPCC, ADDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2053
US

IV. Provider business mailing address

5373 N UNION BLVD STE 200
COLORADO SPRINGS CO
80918-2053
US

V. Phone/Fax

Practice location:
  • Phone: 719-201-5602
  • Fax:
Mailing address:
  • Phone: 719-201-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: