Provider Demographics
NPI:1881045326
Name:UMBRELLA COLLECTIVE INC
Entity Type:Organization
Organization Name:UMBRELLA COLLECTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-663-0163
Mailing Address - Street 1:2919 VALMONT ROAD
Mailing Address - Street 2:STE 104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1350
Mailing Address - Country:US
Mailing Address - Phone:720-663-0163
Mailing Address - Fax:303-658-9871
Practice Address - Street 1:2919 VALMONT ROAD
Practice Address - Street 2:STE 104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1350
Practice Address - Country:US
Practice Address - Phone:720-663-0163
Practice Address - Fax:303-658-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099233311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000166630Medicaid