Provider Demographics
NPI:1558485870
Name:GRACE, RICHARD JON (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JON
Last Name:GRACE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:JON
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:114 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2031
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:970-484-9380
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0005595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional