MEDICARE: PEAKS TO PLAINS COUNSELING, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124734827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAKS TO PLAINS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	205 KEN PRATT BLVD STE 120-40
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-8993
Country	:	US
Telephone Number	:	858-449-1589
Fax Number	:	720-419-0228

Provider Business Practice Location Address
First Line	:	7175 SW BEVELAND RD STE 205
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-8665
Country	:	US
Telephone Number	:	858-449-1589
Fax Number	:	720-419-0228

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	LAURIE KERRIDGE
Credential	:	LPC
Telephone Number	:	858-449-1589

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	09/15/2025

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