Provider Demographics
NPI:1043961113
Name:TREVISAN, RACHEL ROSE (LPCC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSE
Last Name:TREVISAN
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MERCURY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8955
Mailing Address - Country:US
Mailing Address - Phone:970-335-2422
Mailing Address - Fax:
Practice Address - Street 1:1125 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-9033
Practice Address - Country:US
Practice Address - Phone:970-403-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional