Provider Demographics
NPI:1699390393
Name:BOULDER AND THE PINE WELLNESS
Entity Type:Organization
Organization Name:BOULDER AND THE PINE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GORLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:197-445-6569
Mailing Address - Street 1:5540 N ACADEMY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3696
Mailing Address - Country:US
Mailing Address - Phone:719-445-6569
Mailing Address - Fax:
Practice Address - Street 1:4570 HILTON PKWY STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3565
Practice Address - Country:US
Practice Address - Phone:719-445-6569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407371362OtherNPPES