Healthcare Provider Details

I. General information

NPI: 1033635867
Provider Name (Legal Business Name): SOFIA AGUILERA MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2097 CHELSEA DR
LOVELAND CO
80538-4306
US

IV. Provider business mailing address

4333 CORBETT DR # 1173
FORT COLLINS CO
80525-6111
US

V. Phone/Fax

Practice location:
  • Phone: 970-239-1148
  • Fax:
Mailing address:
  • Phone: 970-239-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0016226
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0016789
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: