Healthcare Provider Details

I. General information

NPI: 1073643011
Provider Name (Legal Business Name): FELICITAS A. STRONG CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. FELICITAS A. ELEK

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W. 3RD STREET
LA JUNTA CO
81050-2138
US

IV. Provider business mailing address

413 KIVA COURT
LA JUNTA CO
81050-9503
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-0662
  • Fax:
Mailing address:
  • Phone: 720-394-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6760
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: