Healthcare Provider Details

I. General information

NPI: 1164338208
Provider Name (Legal Business Name): CODY CONNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 E PROSPECT RD # 150
FORT COLLINS CO
80525-9098
US

IV. Provider business mailing address

925 BLUEBELL CT
WINDSOR CO
80550-5521
US

V. Phone/Fax

Practice location:
  • Phone: 970-212-9120
  • Fax:
Mailing address:
  • Phone: 970-488-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002893
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: