Healthcare Provider Details

I. General information

NPI: 1508275314
Provider Name (Legal Business Name): A CONSCIOUS PATH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 REMINGTON ST STE. 8
FORT COLLINS CO
80524-3074
US

IV. Provider business mailing address

503 REMINGTON ST STE. 8
FORT COLLINS CO
80524-3074
US

V. Phone/Fax

Practice location:
  • Phone: 970-222-8586
  • Fax: 970-237-6944
Mailing address:
  • Phone: 970-222-8586
  • Fax: 970-237-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0006045
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923473
License Number StateCO

VIII. Authorized Official

Name: MS. ABBY L PETERFESO
Title or Position: OWNER/ THERAPIST
Credential: LPC
Phone: 970-222-8586