Provider Demographics
NPI:1255440343
Name:MORA-DEROSBY, STEPHANIE FELISA (LPC, LAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:FELISA
Last Name:MORA-DEROSBY
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:FELISA
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4800
Mailing Address - Fax:970-207-4805
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4800
Practice Address - Fax:970-207-4805
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93101YA0400X
CO3385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)