MEDICARE: ANNE KAREN POULSON MA, MED, LPC, NCC

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	LPC0013632	CO
2	101YP2500X	Professional Counselor	LPCC0013632	CO

General Provider Information

NPI Number	:	1992172548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE KAREN POULSON MA, MED, LPC, NCC

Provider Business Mailing Address
First Line	:	1117 PONDEROSA DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4142
Country	:	US
Telephone Number	:	970-217-6823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 PONDEROSA DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4142
Country	:	US
Telephone Number	:	970-217-6823
Fax Number	:

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

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	11/06/2015

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