MEDICARE: VIVIANA C VETHENCOURT 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	101YM0800X	Mental Health Counselor	MH17410	FL
2	101YP2500X	Professional Counselor	0019387	CO
3	101YP2500X	Professional Counselor	0020736	CO

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	:	1316588874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA C VETHENCOURT LPC

Provider Business Mailing Address
First Line	:	1345 IVY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-2643
Country	:	US
Telephone Number	:	954-534-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 IVY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-2643
Country	:	US
Telephone Number	:	954-534-6744
Fax Number	:

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

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	11/05/2025

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