Healthcare Provider Details

I. General information

NPI: 1922478718
Provider Name (Legal Business Name): ROSE WALKER M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 RACQUETTE DR
FORT COLLINS CO
80524-4851
US

IV. Provider business mailing address

208 RACQUETTE DR
FORT COLLINS CO
80524-4851
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 970-310-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015034352
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024151
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03618
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: