Provider Demographics
NPI:1669723235
Name:GREENWELL, LAUREN CALDWELL (CAC I)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CALDWELL
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:CAC I
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3279
Mailing Address - Country:US
Mailing Address - Phone:303-413-6348
Mailing Address - Fax:
Practice Address - Street 1:975 NORTH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3279
Practice Address - Country:US
Practice Address - Phone:303-413-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0007527101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health