MEDICARE: GWEN BELL LAC

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	ACD 0000370	CO

General Provider Information

NPI Number	:	1952730673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN BELL LAC

Provider Business Mailing Address
First Line	:	2329 STONECREST DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-1358
Country	:	US
Telephone Number	:	970-221-3415
Fax Number	:

Provider Business Practice Location Address
First Line	:	4529 STOVER ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3261
Country	:	US
Telephone Number	:	303-815-3988
Fax Number	:

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

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	05/12/2021

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Directions to “ GWEN BELL LAC” Practice Location

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