MEDICARE: OZ PSYCHOTHERAPY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851809123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZ PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	2850 MCCLELLAND DR STE 3000M
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	970-632-3332
Fax Number	:	970-449-7404

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3000M
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	970-632-3332
Fax Number	:	970-449-7404

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JENNIFER STEPHENSON
Credential	:	M.A.
Telephone Number	:	970-632-3332

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	12/23/2019

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