Provider Demographics
NPI: | 1568579373 |
---|---|
Name: | MACLEOD, ANGUS (LPC, CAS, MS) |
Entity type: | Individual |
Prefix: | |
First Name: | ANGUS |
Middle Name: | |
Last Name: | MACLEOD |
Suffix: | |
Gender: | M |
Credentials: | LPC, CAS, MS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4856 INNOVATION DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT COLLINS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80525-5539 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-494-4200 |
Mailing Address - Fax: | 844-270-1824 |
Practice Address - Street 1: | 4856 INNOVATION DR |
Practice Address - Street 2: | |
Practice Address - City: | FORT COLLINS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80525-5539 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-494-4200 |
Practice Address - Fax: | 844-270-1824 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-25 |
Last Update Date: | 2025-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | ACC.0997283 | 101YA0400X |
CO | LPC.0004281 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 08920061 | Medicaid |