=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598985376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA CELESTE HERN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2641 SOUTHPARK RD
-----------------------------------------------------
City | FLORISSANT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80816-8991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-465-7442
-----------------------------------------------------
Fax | 719-960-2279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1067 E US HIGHWAY 24 # 171
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80863-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-465-7442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 5290
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------