Provider Demographics
NPI:1437895224
Name:BUENO, GRACIE RODRIGUEZ (LPC)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:RODRIGUEZ
Last Name:BUENO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BERYL WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2316
Mailing Address - Country:US
Mailing Address - Phone:303-994-0266
Mailing Address - Fax:
Practice Address - Street 1:305 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4248
Practice Address - Country:US
Practice Address - Phone:970-663-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional