MEDICARE: PATRICIA CORRENTE LPC, CAC III

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	4460	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	6487	CO

General Provider Information

NPI Number	:	1861557811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CORRENTE LPC, CAC III

Provider Business Mailing Address
First Line	:	1420 COMMANCHERO DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3312
Country	:	US
Telephone Number	:	719-306-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 ELWELL ST BLDG 6236
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4356
Country	:	US
Telephone Number	:	719-526-8560
Fax Number	:	719-526-8758

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	10/28/2014

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