MEDICARE: OLIVIA MCKINZIE LPCC. ADDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADDC.0000554	CO
2	101YM0800X	Mental Health Counselor	LPCC.0023170	CO

General Provider Information

NPI Number	:	1205719507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MCKINZIE LPCC. ADDC

Provider Business Mailing Address
First Line	:	1206 ELM ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-1752
Country	:	US
Telephone Number	:	303-915-3041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 ELM ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-1752
Country	:	US
Telephone Number	:	303-915-3041
Fax Number	:

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

Provider Enumeration Date	:	07/26/2025
Last Update Date	:	07/26/2025

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