Healthcare Provider Details

I. General information

NPI: 1164002887
Provider Name (Legal Business Name): TREVOR LENZ B.S., C.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 S COLLEGE AVE
FORT COLLINS CO
80525-1007
US

IV. Provider business mailing address

1644 S COLLEGE AVE
FORT COLLINS CO
80525-1007
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-0999
  • Fax:
Mailing address:
  • Phone: 970-221-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0998578
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: