Healthcare Provider Details

I. General information

NPI: 1740926187
Provider Name (Legal Business Name): SPECIALTY COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 STOVER ST BLDG C
FORT COLLINS CO
80525-4641
US

IV. Provider business mailing address

6820 COLONY HILLS LN
FORT COLLINS CO
80525-6987
US

V. Phone/Fax

Practice location:
  • Phone: 970-942-3031
  • Fax:
Mailing address:
  • Phone: 208-571-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BRANDON TURNER
Title or Position: PROVISIONAL THERAPIST
Credential:
Phone: 208-571-1614