Provider Demographics
NPI:1821465758
Name:STONECIPHER, DERRICK R (MS)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:R
Last Name:STONECIPHER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 POUDRE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-7516
Mailing Address - Country:US
Mailing Address - Phone:970-430-3296
Mailing Address - Fax:
Practice Address - Street 1:3030 S COLLEGE AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2557
Practice Address - Country:US
Practice Address - Phone:970-430-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional