Provider Demographics
NPI:1558950675
Name:GOLAN, MAYA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GOLAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 N FOOTHILLS HWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9315
Mailing Address - Country:US
Mailing Address - Phone:720-900-9820
Mailing Address - Fax:
Practice Address - Street 1:8426 N FOOTHILLS HWY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9315
Practice Address - Country:US
Practice Address - Phone:720-900-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional