Healthcare Provider Details

I. General information

NPI: 1104313758
Provider Name (Legal Business Name): ELIZABETH MARINO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2342
  • Fax: 970-335-2438
Mailing address:
  • Phone: 970-335-2342
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0016404
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: