Provider Demographics
NPI:1801903695
Name:LANDON, MICHELLE LYNNE (LCSW, CAC II)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:LANDON
Suffix:
Gender:F
Credentials:LCSW, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W HARVARD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5200
Mailing Address - Country:US
Mailing Address - Phone:970-286-8892
Mailing Address - Fax:970-797-1333
Practice Address - Street 1:155 W HARVARD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5200
Practice Address - Country:US
Practice Address - Phone:970-286-8892
Practice Address - Fax:970-797-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7621041C0700X
CO7282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)