Healthcare Provider Details

I. General information

NPI: 1104756188
Provider Name (Legal Business Name): MAJESTIC ACCESS AND RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTH MASON STREET
FORT COLLINS CO
80523-0001
US

IV. Provider business mailing address

700 SOUTH MASON STREET
FORT COLLINS CO
80523-0001
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-9690
  • Fax:
Mailing address:
  • Phone: 970-658-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRADLEY THOMAS CONNER
Title or Position: PROFESSOR
Credential: PH.D.
Phone: 310-383-8088