Healthcare Provider Details

I. General information

NPI: 1871061960
Provider Name (Legal Business Name): MARISSA EWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S COLLEGE AVE # 101
FORT COLLINS CO
80524-3003
US

IV. Provider business mailing address

3642 RONALD REAGAN AVE
WELLINGTON CO
80549-2401
US

V. Phone/Fax

Practice location:
  • Phone: 720-204-8539
  • Fax:
Mailing address:
  • Phone: 720-472-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023734
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: