Healthcare Provider Details

I. General information

NPI: 1508781030
Provider Name (Legal Business Name): KAINE FREDRICKSON LPC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E ELIZABETH ST STE 3
FORT COLLINS CO
80524-4066
US

IV. Provider business mailing address

1221 E ELIZABETH ST STE 3
FORT COLLINS CO
80524-4066
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-1337
  • Fax:
Mailing address:
  • Phone: 970-682-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024310
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: