Provider Demographics
NPI:1710009766
Name:MORTENSEN, MICHELE L (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:MORTENSEN
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 1:98 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2180
Mailing Address - Country:US
Mailing Address - Phone:303-264-7521
Mailing Address - Fax:303-474-6852
Practice Address - Street 1:60651 US HWY 285
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2180
Practice Address - Country:US
Practice Address - Phone:303-264-7521
Practice Address - Fax:303-474-6852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA.0006301101YA0400X
101YA0400X, 101YM0800X
COLPC.0012260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000155437Medicaid