MEDICARE: POLARIS PARTNERS COUNSELING AND CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker
3	101YP2500X	Professional Counselor
4	106H00000X	Marriage & Family Therapist
5	101YM0800X	Mental Health 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

General Provider Information

NPI Number	:	1962172635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLARIS PARTNERS COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	155 S MADISON ST STE 306
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3014
Country	:	US
Telephone Number	:	970-576-1717
Fax Number	:	208-567-5844

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3400
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2572
Country	:	US
Telephone Number	:	866-285-2929
Fax Number	:	208-567-5844

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DAMOND DOTSON
Credential	:	PHD, LMFT
Telephone Number	:	970-576-1717

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	10/18/2022

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Directions to “POLARIS PARTNERS COUNSELING AND CONSULTING LLC ” Practice Location

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