Healthcare Provider Details

I. General information

NPI: 1285383802
Provider Name (Legal Business Name): CLAIRE ELISE COBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAIRE MUECK

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BOARDWALK DR
FORT COLLINS CO
80525-5945
US

IV. Provider business mailing address

4115 BOARDWALK DR
FORT COLLINS CO
80525-5945
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-4580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14240817-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-86279
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5771577
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0021068
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: