Healthcare Provider Details

I. General information

NPI: 1184531808
Provider Name (Legal Business Name): MACY PEDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 S COLLEGE AVE
FORT COLLINS CO
80525-1007
US

IV. Provider business mailing address

517 W MULBERRY ST
FORT COLLINS CO
80521-3608
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-0999
  • Fax:
Mailing address:
  • Phone: 952-270-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: