Provider Demographics
NPI:1336873066
Name:THE OTHER ROAD COUNSELING PLLC
Entity Type:Organization
Organization Name:THE OTHER ROAD COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORIE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:SMOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-573-1655
Mailing Address - Street 1:2004 W 15TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3551
Mailing Address - Country:US
Mailing Address - Phone:720-446-6549
Mailing Address - Fax:
Practice Address - Street 1:6640 GUNPARK DR STE 101
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-7001
Practice Address - Country:US
Practice Address - Phone:970-217-2486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty