Healthcare Provider Details

I. General information

NPI: 1063822856
Provider Name (Legal Business Name): PATRICIA ESPINOZA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST STE 320
PUEBLO CO
81003-3139
US

IV. Provider business mailing address

PO BOX 3421
PUEBLO CO
81005-0421
US

V. Phone/Fax

Practice location:
  • Phone: 719-792-9237
  • Fax:
Mailing address:
  • Phone: 719-792-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0014306
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00493400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: