Provider Demographics
NPI:1558934349
Name:WELLTALK
Entity Type:Organization
Organization Name:WELLTALK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-210-9534
Mailing Address - Street 1:2855 ROCK CREEK CIR UNIT 179
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4616
Mailing Address - Country:US
Mailing Address - Phone:415-254-8781
Mailing Address - Fax:
Practice Address - Street 1:2027 11TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5101
Practice Address - Country:US
Practice Address - Phone:720-210-9534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty