Provider Demographics
NPI:1508182122
Name:DYKSTRA, RITA RYAN (LPC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:RYAN
Last Name:DYKSTRA
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 1:1136 EAST STUART STREET
Mailing Address - Street 2:BUILDING 2, SUITE 2240
Mailing Address - City:FORT
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-391-0200
Mailing Address - Fax:970-226-5032
Practice Address - Street 1:1136 EAST STUART STREET
Practice Address - Street 2:BUILDING 2, SUITE 2240
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-391-0200
Practice Address - Fax:970-226-5032
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional