Healthcare Provider Details

I. General information

NPI: 1790696797
Provider Name (Legal Business Name): ANDREW CHARLES RATH MA, NCC, LPCC, ADDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E FIRST ST
TRINIDAD CO
81082-3010
US

IV. Provider business mailing address

427 W COLORADO AVE
TRINIDAD CO
81082-2418
US

V. Phone/Fax

Practice location:
  • Phone: 719-252-5493
  • Fax:
Mailing address:
  • Phone: 719-649-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: