| Neurofeedback Clinic Of Northern Colorado Llc | |
|
4115 Boardwalk Drive, Suite 100 Fort Collins CO 80525-5945 | |
| (970) 493-4580 | |
| (970) 797-2859 |
| Full Name | Neurofeedback Clinic Of Northern Colorado Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4115 Boardwalk Drive, Suite 100, Fort Collins, Colorado |
| Authorized Official Name and Position | Lisa Pendleton (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9704934580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurofeedback Clinic Of Northern Colorado Llc 4115 Boardwalk Dr Suite 100 Fort Collins CO 80525-5945 Ph: (970) 493-4580 | Neurofeedback Clinic Of Northern Colorado Llc 4115 Boardwalk Drive, Suite 100 Fort Collins CO 80525-5945 Ph: (970) 493-4580 |
| NPI Number | 1659794477 |
|---|---|
| Provider Enumeration Date | 01/30/2014 |
| Last Update Date | 05/30/2025 |
| Certification Date | 05/30/2025 |
| Medicare PECOS PAC ID | 6406162353 |
|---|---|
| Medicare Enrollment ID | O20150909000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659794477 | NPI | - | NPPES |
| Provider Name | Randall S Sims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316399686 PECOS PAC ID: 0143513523 Enrollment ID: I20160722000192 |
| Provider Name | Lesley Sanfilippo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215221270 PECOS PAC ID: 0840427563 Enrollment ID: I20181024002938 |
| Provider Name | Kellie Burns |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093093684 PECOS PAC ID: 6204163066 Enrollment ID: I20190816000946 |
| Provider Name | Jodie Ball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356850846 PECOS PAC ID: 2961821178 Enrollment ID: I20201007000824 |
| Provider Name | Alix Dinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073157962 PECOS PAC ID: 4385063502 Enrollment ID: I20201007001421 |
| Provider Name | Leslie Lynn Larsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053865915 PECOS PAC ID: 1355735432 Enrollment ID: I20220307001841 |
| Provider Name | Jinny Mortensen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326472846 PECOS PAC ID: 6103271911 Enrollment ID: I20241203001140 |
| Provider Name | Megan Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134737067 PECOS PAC ID: 3577099076 Enrollment ID: I20241206002811 |
| Provider Name | Jessica A Gillmor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679944136 PECOS PAC ID: 0648706168 Enrollment ID: I20241207000105 |
| Provider Name | Claire Elise Coburn Mueck |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285383802 PECOS PAC ID: 3072049501 Enrollment ID: I20241209000233 |
| Provider Name | Sarah Hervey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033630504 PECOS PAC ID: 1153857552 Enrollment ID: I20241209003248 |
| Provider Name | Tracy Sarli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932837341 PECOS PAC ID: 6204362585 Enrollment ID: I20241210002483 |
| Provider Name | Kiara Dixon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528438686 PECOS PAC ID: 2062948276 Enrollment ID: I20241211003322 |
| Provider Name | Jennifer L Wayman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023444130 PECOS PAC ID: 3072049121 Enrollment ID: I20241212000751 |
| Provider Name | Sheyna Button |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467171561 PECOS PAC ID: 9133655129 Enrollment ID: I20241213002717 |
| Provider Name | Chelsea Anita Scheunert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093271868 PECOS PAC ID: 7810426483 Enrollment ID: I20250128000516 |
| Provider Name | Vanessa Schneider |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942405006 PECOS PAC ID: 1658801345 Enrollment ID: I20250211001112 |
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