MEDICARE: MRS. DEBORAH LOUISE FENTON-NICHOLS LPC, LAC

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	332	CO
2	101YM0800X	Mental Health Counselor	5358	CO

General Provider Information

NPI Number	:	1285956359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH LOUISE FENTON-NICHOLS LPC, LAC

Provider Business Mailing Address
First Line	:	PO BOX 2124
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80522-2124
Country	:	US
Telephone Number	:	970-443-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E. BOARDWALK DRIVE
Second Line	:	BUILDING 6A
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3093
Country	:	US
Telephone Number	:	970-443-1038
Fax Number	:

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	09/12/2019

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