MEDICARE: MS. CYNTHIA ANN LITTON-FANNING LCSW

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	1041C0700X	Clinical Social Worker	991621	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	613519	OTHER	CO	MEDICARE PTAN

General Provider Information

NPI Number	:	1750444220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ANN LITTON-FANNING LCSW

Provider Business Mailing Address
First Line	:	343 W DRAKE RD
Second Line	:	SUITE 260
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-207-1080
Fax Number	:	970-207-1640

Provider Business Practice Location Address
First Line	:	343 W DRAKE RD
Second Line	:	SUITE 260
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-207-1080
Fax Number	:	970-207-1640

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/11/2009

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