| Poudre Psychotherapy Partners | |
|
2625 Redwing Rd Ste 110 Fort Collins CO 80526-2878 | |
| (970) 829-0761 | |
| Not Available |
| Full Name | Poudre Psychotherapy Partners |
|---|---|
| Speciality | Counselor |
| Location | 2625 Redwing Rd Ste 110, Fort Collins, Colorado |
| Authorized Official Name and Position | Loni Beall (OWNER) |
| Authorized Official Contact | 9708290761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poudre Psychotherapy Partners 2739 Bianco Dr Fort Collins CO 80521-4917 Ph: (708) 290-7619 | Poudre Psychotherapy Partners 2625 Redwing Rd Ste 110 Fort Collins CO 80526-2878 Ph: (970) 829-0761 |
| NPI Number | 1538756184 |
|---|---|
| Provider Enumeration Date | 12/30/2020 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/08/2021 |
| Medicare PECOS PAC ID | 3476944174 |
|---|---|
| Medicare Enrollment ID | O20220106000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538756184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Jenna Raymond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699124487 PECOS PAC ID: 8224445291 Enrollment ID: I20210319000039 |
| Provider Name | Alicia Maria Matheson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942881131 PECOS PAC ID: 5092123422 Enrollment ID: I20210422002585 |
| Provider Name | Loni Beall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760991665 PECOS PAC ID: 9133536105 Enrollment ID: I20240307002925 |
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