Provider Demographics
NPI:1164083150
Name:BONAIUTO, RACHAEL L (LPC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:BONAIUTO
Suffix:
Gender:F
Credentials:LPC, BC-DMT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:L
Other - Last Name:SKOLNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 30TH ST STE 218B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1006
Mailing Address - Country:US
Mailing Address - Phone:303-827-6450
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST STE 218B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1006
Practice Address - Country:US
Practice Address - Phone:303-827-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006313101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor