Healthcare Provider Details

I. General information

NPI: 1578884359
Provider Name (Legal Business Name): RAE ANN BARTELS LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 HIGHWAY 82
GLENWOOD SPRINGS CO
81601
US

IV. Provider business mailing address

17 BRYAN LOOP
PARACHUTE CO
81635-7708
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2583
  • Fax: 970-928-8852
Mailing address:
  • Phone: 970-948-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0000514
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0012426
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: