MEDICARE: REGINA HARIRI LPC, LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1073352712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA HARIRI LPC, LLC

Provider Business Mailing Address
First Line	:	918 DEERHURST CIR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6917
Country	:	US
Telephone Number	:	970-227-3225
Fax Number	:	970-206-4843

Provider Business Practice Location Address
First Line	:	109 W BEAVER AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-2123
Country	:	US
Telephone Number	:	970-227-3225
Fax Number	:	970-206-4843

Authorized Official
Title or Position	:	OWNER/ MANAGER
Name	:	REGINA HARIRI
Credential	:	LPC
Telephone Number	:	970-227-3225

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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