Provider Demographics
NPI:1841789526
Name:GENESA FALCAO PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:GENESA FALCAO PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:GENESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCAO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:301-221-4472
Mailing Address - Street 1:4965 TWIN LAKES RD APT 72
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3892
Mailing Address - Country:US
Mailing Address - Phone:301-221-4472
Mailing Address - Fax:833-575-7126
Practice Address - Street 1:1800 30TH ST STE 207
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1026
Practice Address - Country:US
Practice Address - Phone:720-582-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0012470OtherSTATE OF COLORADO