Provider Demographics
NPI:1154953776
Name:ARLENEA, WILLOW MAE (MA)
Entity type:Individual
Prefix:
First Name:WILLOW
Middle Name:MAE
Last Name:ARLENEA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 19TH ST LOT 379
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0663
Mailing Address - Country:US
Mailing Address - Phone:303-544-0054
Mailing Address - Fax:
Practice Address - Street 1:4500 19TH ST LOT 379
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0663
Practice Address - Country:US
Practice Address - Phone:303-544-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional