Healthcare Provider Details

I. General information

NPI: 1598130007
Provider Name (Legal Business Name): MR. ANDREW MOTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 STOVER ST BLDG C
FORT COLLINS CO
80525-4641
US

IV. Provider business mailing address

5840 VENUS AVE
FORT COLLINS CO
80525-3943
US

V. Phone/Fax

Practice location:
  • Phone: 970-942-3031
  • Fax:
Mailing address:
  • Phone: 720-310-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024901
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: