Provider Demographics
NPI:1891826277
Name:BOULTON, JULIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:BOULTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GARDEN OF THE GODS RD.
Mailing Address - Street 2:STE. 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-598-3232
Mailing Address - Fax:719-598-2709
Practice Address - Street 1:300 GARDEN OF THE GODS RD
Practice Address - Street 2:STE. 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4240
Practice Address - Country:US
Practice Address - Phone:719-598-3232
Practice Address - Fax:719-598-2709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health