Provider Demographics
NPI:1043874480
Name:ATENCIO, LAUREN (BA, CAC II)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:BA, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 LA MONTANA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6735
Mailing Address - Country:US
Mailing Address - Phone:719-528-3500
Mailing Address - Fax:719-528-2433
Practice Address - Street 1:2270 LA MONTANA WAY STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6735
Practice Address - Country:US
Practice Address - Phone:719-528-3500
Practice Address - Fax:719-528-2433
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)