Provider Demographics
NPI:1073643011
Name:STRONG, FELICITAS A (CACIII)
Entity Type:Individual
Prefix:
First Name:FELICITAS
Middle Name:A
Last Name:STRONG
Suffix:
Gender:F
Credentials:CACIII
Other - Prefix:MRS
Other - First Name:FELICITAS
Other - Middle Name:A
Other - Last Name:ELEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:413 KIVA COURT
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-9503
Mailing Address - Country:US
Mailing Address - Phone:720-394-9064
Mailing Address - Fax:
Practice Address - Street 1:114 W. 3RD STREET
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-383-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6760101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)