Healthcare Provider Details

I. General information

NPI: 1619887676
Provider Name (Legal Business Name): CHRISTINA BAGLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LANCER DR
FORT COLLINS CO
80521-1609
US

IV. Provider business mailing address

1600 LANCER DR
FORT COLLINS CO
80521-1609
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-4900
  • Fax: 970-638-3189
Mailing address:
  • Phone: 970-488-4900
  • Fax: 970-638-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023460
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: