Provider Demographics
NPI:1992172548
Name:POULSON, ANNE KAREN (MA, MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KAREN
Last Name:POULSON
Suffix:
Gender:F
Credentials:MA, MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4142
Mailing Address - Country:US
Mailing Address - Phone:970-217-6823
Mailing Address - Fax:
Practice Address - Street 1:1117 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-4142
Practice Address - Country:US
Practice Address - Phone:970-217-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0013632101YP2500X
COLPCC0013632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional