Provider Demographics
NPI:1780421735
Name:MARKO, MAXIMILIAN STEPHEN (MS, LPCC)
Entity type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:STEPHEN
Last Name:MARKO
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W OAK ST FL 4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2734
Mailing Address - Country:US
Mailing Address - Phone:970-632-1133
Mailing Address - Fax:
Practice Address - Street 1:215 W OAK ST FL 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2734
Practice Address - Country:US
Practice Address - Phone:970-632-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health