Healthcare Provider Details

I. General information

NPI: 1013772144
Provider Name (Legal Business Name): TAYLOR MARIE CAMPION LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BOARDWALK DR
FORT COLLINS CO
80525-5945
US

IV. Provider business mailing address

1208 ROBERTSON ST
FORT COLLINS CO
80524-3921
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-4580
  • Fax:
Mailing address:
  • Phone: 215-500-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024529
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: