Provider Demographics
NPI:1699315291
Name:DESAI, KUSH TARUN (LCSW)
Entity type:Individual
Prefix:MR
First Name:KUSH
Middle Name:TARUN
Last Name:DESAI
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 S COLLEGE AVE UNIT 210
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:970-207-4857
Practice Address - Fax:970-207-4857
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2025-02-19
Deactivation Date:2020-04-02
Deactivation Code:
Reactivation Date:2020-04-08
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-13351041C0700X
COCSW.099279381041C0700X, 1041C0700X
DEQ1-00118981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY205170200Medicaid
CO9000181492Medicaid
CO9000181492Medicaid