Provider Demographics
NPI:1285185785
Name:MCKEON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CANDELARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2519 S SHIELDS ST
Mailing Address - Street 2:STE 1K PMB 1093
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1855
Mailing Address - Country:US
Mailing Address - Phone:970-759-7095
Mailing Address - Fax:970-360-3543
Practice Address - Street 1:2519 S SHIELDS ST
Practice Address - Street 2:STE 1K PMB 1093
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1855
Practice Address - Country:US
Practice Address - Phone:970-759-7095
Practice Address - Fax:970-360-3543
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002228101YA0400X
CO0009922632104100000X
COCSW.099273811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker