Healthcare Provider Details

I. General information

NPI: 1891127353
Provider Name (Legal Business Name): ABBIE R CONNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N WILSON AVE
LOVELAND CO
80537-4461
US

IV. Provider business mailing address

125 CRESTRIDGE ST
FORT COLLINS CO
80525-3934
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-9870
  • Fax: 970-377-0967
Mailing address:
  • Phone: 970-494-9761
  • Fax: 970-377-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA.0006703
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923028
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: