Provider Demographics
NPI:1790944916
Name:THELOSEN, MOLLY ANNE (BA)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANNE
Last Name:THELOSEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:ERICSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2045 JOSLYN PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1948
Mailing Address - Country:US
Mailing Address - Phone:303-668-3413
Mailing Address - Fax:
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-668-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor