Provider Demographics
NPI:1760157879
Name:FORTUNE, LINDSEY (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 LARIAT CIR
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-9004
Mailing Address - Country:US
Mailing Address - Phone:719-221-4379
Mailing Address - Fax:
Practice Address - Street 1:5426 N ACADEMY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3686
Practice Address - Country:US
Practice Address - Phone:719-221-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018802101YP2500X
CO322607101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty