MEDICARE: A NORTH STAR

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	15	CO
2	101YM0800X	Mental Health Counselor	4420	CO
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	7223	CO

General Provider Information

NPI Number	:	1437580156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NORTH STAR

Provider Business Mailing Address
First Line	:	301 SPAULDING LN LOT 15
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1858
Country	:	US
Telephone Number	:	970-308-4552
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SPAULDING LN LOT 15
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1858
Country	:	US
Telephone Number	:	970-308-4552
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBRA PAULISON
Credential	:	CAC II
Telephone Number	:	970-308-4552

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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Directions to “A NORTH STAR ” Practice Location

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