Provider Demographics
NPI:1073371290
Name:SOULTERRA COUSNSELING P.L.L.C
Entity Type:Organization
Organization Name:SOULTERRA COUSNSELING P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:801-872-8030
Mailing Address - Street 1:1509 FOSTER CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6713
Mailing Address - Country:US
Mailing Address - Phone:801-872-8030
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR STE 204
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4252
Practice Address - Country:US
Practice Address - Phone:801-872-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty