MEDICARE: AFFIRM COUNSELING LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1750061289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFIRM COUNSELING LLC

Provider Business Mailing Address
First Line	:	1281 E MAGNOLIA ST STE D
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4794
Country	:	US
Telephone Number	:	970-235-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3200
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2572
Country	:	US
Telephone Number	:	970-235-0011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TYLER WOODY
Credential	:	LPC
Telephone Number	:	970-235-0011

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	11/22/2024

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