Healthcare Provider Details

I. General information

NPI: 1124953922
Provider Name (Legal Business Name): MS. LARA PETROPOULOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7353 SISTERS GRV
COLORADO SPRINGS CO
80923-2615
US

IV. Provider business mailing address

2605 E SERENDIPITY CIR APT 350
COLORADO SPRINGS CO
80917-3926
US

V. Phone/Fax

Practice location:
  • Phone: 719-444-8484
  • Fax: 719-574-9005
Mailing address:
  • Phone: 708-965-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0024468
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002850
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: