Provider Demographics
NPI:1679018352
Name:BOETTGER, CHERYL (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BOETTGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 POWDERHORN CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3175
Mailing Address - Country:US
Mailing Address - Phone:307-286-3336
Mailing Address - Fax:
Practice Address - Street 1:564 POWDERHORN CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3175
Practice Address - Country:US
Practice Address - Phone:307-286-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1751101Y00000X
COLPC.0015641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor