Healthcare Provider Details

I. General information

NPI: 1205686391
Provider Name (Legal Business Name): VANESSA GRACE FAGNANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5921 MIDDLEFIELD RD STE 203
LITTLETON CO
80123-2860
US

IV. Provider business mailing address

4825 COLLINSVILLE PL
HIGHLANDS RANCH CO
80130-6824
US

V. Phone/Fax

Practice location:
  • Phone: 720-770-1112
  • Fax:
Mailing address:
  • Phone: 720-934-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0021794
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: