Healthcare Provider Details

I. General information

NPI: 1396355244
Provider Name (Legal Business Name): KIDSTUFF CHILD AND FAMILY COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 ROBERTSON ST. STE. 120
FORT COLLINS CO
80524
US

IV. Provider business mailing address

1440 W. 29TH ST. STE. 100
LOVELAND CO
80538
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-7061
  • Fax: 970-292-8194
Mailing address:
  • Phone: 970-775-7061
  • Fax: 970-292-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE EVANS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 970-775-7061