Healthcare Provider Details

I. General information

NPI: 1811340912
Provider Name (Legal Business Name): PROFESSIONAL COUNSELING AND HYPNOSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 ROBERTSON ST WEST WING, LWR LEVEL
FORT COLLINS CO
80524-3900
US

IV. Provider business mailing address

1006 ROBERTSON ST WEST WING, LWR LEVEL
FORT COLLINS CO
80524-3900
US

V. Phone/Fax

Practice location:
  • Phone: 970-416-9595
  • Fax:
Mailing address:
  • Phone: 970-416-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA M. MICHAELS
Title or Position: PRESIDENT/OWNER
Credential: LPC
Phone: 970-416-9595