Healthcare Provider Details

I. General information

NPI: 1790465854
Provider Name (Legal Business Name): LIFE CYCLE COUNSELING AND CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 REDWING RD STE 175
FORT COLLINS CO
80526-6324
US

IV. Provider business mailing address

719 CHERRY ST
FORT COLLINS CO
80521-1912
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-8299
  • Fax:
Mailing address:
  • Phone: 720-310-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL MCCARTHY
Title or Position: THERAPIST
Credential: MA, LPC, LAC
Phone: 720-310-8299