Provider Demographics
NPI:1811038326
Name:NEUROAGILITY, PC
Entity Type:Organization
Organization Name:NEUROAGILITY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-417-1797
Mailing Address - Street 1:2501 WALNUT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5753
Mailing Address - Country:US
Mailing Address - Phone:303-417-1797
Mailing Address - Fax:303-442-1125
Practice Address - Street 1:2501 WALNUT ST STE 205
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5753
Practice Address - Country:US
Practice Address - Phone:303-417-1797
Practice Address - Fax:303-442-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty