Provider Demographics
NPI:1205478468
Name:BOERTJE, ALICE ANNE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ANNE
Last Name:BOERTJE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E MONUMENT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1061
Mailing Address - Country:US
Mailing Address - Phone:312-369-9422
Mailing Address - Fax:
Practice Address - Street 1:130 E MONUMENT ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1061
Practice Address - Country:US
Practice Address - Phone:312-369-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014114101YM0800X
COLPC.0019250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0019250OtherSTATE BOARD OF LICENSED PROFESSIONAL COUNSELING EXAMINERS
IL180.014114OtherLCPC