=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871487231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRIFTWOOD SPRINGS COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3555 STANFORD RD STE 140
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-4680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-727-7154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1719 BANYAN DR
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80526-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-251-0287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | JACKELYN K FRITSCH
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 720-727-7154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------