Provider Demographics
NPI:1891069175
Name:OLK, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:OLK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BLAKE ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1474
Mailing Address - Country:US
Mailing Address - Phone:720-244-9884
Mailing Address - Fax:
Practice Address - Street 1:2945 CENTER GREEN CT
Practice Address - Street 2:STE G212
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2359
Practice Address - Country:US
Practice Address - Phone:720-244-9884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health