Provider Demographics
NPI:1023600350
Name:BACORN, DIANNE M (LPC, LAC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:BACORN
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 MIDPOINT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4306
Mailing Address - Country:US
Mailing Address - Phone:970-498-7581
Mailing Address - Fax:
Practice Address - Street 1:2255 MIDPOINT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4306
Practice Address - Country:US
Practice Address - Phone:970-498-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YA0400X
COLPC0014693101YP2500X
COACD0001092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional