Healthcare Provider Details

I. General information

NPI: 1174748008
Provider Name (Legal Business Name): LIGHT OF THE ROCKIES CHRISTIAN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E HORSETOOTH RD BLDG 2101
FORT COLLINS CO
80525-3196
US

IV. Provider business mailing address

375 E HORSETOOTH RD BLDG 2101
FORT COLLINS CO
80525-3196
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-1735
  • Fax: 970-224-4893
Mailing address:
  • Phone: 970-484-1735
  • Fax: 970-224-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number940
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ROBERTS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 970-484-1735