Provider Demographics
NPI:1013549484
Name:SKINNER, ADAM PATRICK (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 ENDEAVOR WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-3644
Mailing Address - Country:US
Mailing Address - Phone:719-301-1071
Mailing Address - Fax:
Practice Address - Street 1:6805 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1977
Practice Address - Country:US
Practice Address - Phone:719-301-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional