MEDICARE: MONIQUE VINCENT LAC, LPCC

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	0022301	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0002868	CO

General Provider Information

NPI Number	:	1841074663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE VINCENT LAC, LPCC

Provider Business Mailing Address
First Line	:	3055 29TH ST APT 102
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1323
Country	:	US
Telephone Number	:	774-217-0359
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 29TH ST APT 102
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1323
Country	:	US
Telephone Number	:	774-217-0359
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	01/30/2026

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