Healthcare Provider Details

I. General information

NPI: 1013743970
Provider Name (Legal Business Name): SCOTT DENNIS SLAYBACK COUNSELOR IN TRAININ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 MCCLELLAND DR STE 2000
FORT COLLINS CO
80525-2581
US

IV. Provider business mailing address

2850 MCCLELLAND DR STE 2000
FORT COLLINS CO
80525-2581
US

V. Phone/Fax

Practice location:
  • Phone: 970-670-0509
  • Fax:
Mailing address:
  • Phone: 970-670-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0023309
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: