Provider Demographics
NPI:1700913647
Name:POLCE, LARA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:MARIE
Last Name:POLCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:MARIE
Other - Last Name:DANGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:702-074-8579
Mailing Address - Fax:970-207-4885
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:702-074-8579
Practice Address - Fax:970-207-4885
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6497101YA0400X
COLPC.0004649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)