=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972226306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISSA MARIE HARRINGTON MA,LSC,LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2022
-----------------------------------------------------
Last Update Date | 09/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 STATE AVE STE 206
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-334-2369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 EDGEMONT BLVD
-----------------------------------------------------
City | ALAMOSA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81101-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 24382731
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC.0018718
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------