Healthcare Provider Details

I. General information

NPI: 1497674568
Provider Name (Legal Business Name): REBECCA LEE CLAROS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

858 DAFFODIL ST
FOUNTAIN CO
80817-4145
US

IV. Provider business mailing address

858 DAFFODIL ST
FOUNTAIN CO
80817-4145
US

V. Phone/Fax

Practice location:
  • Phone: 719-354-5818
  • Fax:
Mailing address:
  • Phone: 719-354-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000002540
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: