MEDICARE: DR. PATRICIA MESTAS VIGIL PHD

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	103TC1900X	Counseling Psychologist	1494	CO

General Provider Information

NPI Number	:	1497184915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA MESTAS VIGIL PHD

Provider Business Mailing Address
First Line	:	5815 AUBURN DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4169
Country	:	US
Telephone Number	:	970-219-1836
Fax Number	:	970-491-1077

Provider Business Practice Location Address
First Line	:	5815 AUBURN DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4169
Country	:	US
Telephone Number	:	970-219-1836
Fax Number	:	970-491-1077

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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