MEDICARE: TRINITY ALISE SCROGGS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC.0017405	CO
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1003451303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINITY ALISE SCROGGS LPC

Provider Business Mailing Address
First Line	:	4521 SIERRA RICA RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-3893
Country	:	US
Telephone Number	:	719-760-9632
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 SIERRA RICA RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-3893
Country	:	US
Telephone Number	:	719-760-9632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2019
Last Update Date	:	02/12/2024

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