=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689374464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA ANN O'ROURKE LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2023
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 HIGHWAY 72
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80466-5272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-304-0696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1566
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80466-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-304-0696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC.0019185
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------