Provider Demographics
NPI:1770298929
Name:BOYER, LAURIE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 E 2ND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4270
Mailing Address - Country:US
Mailing Address - Phone:303-523-3053
Mailing Address - Fax:
Practice Address - Street 1:100 JENKINS RANCH RD UNIT E6
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-9473
Practice Address - Country:US
Practice Address - Phone:970-551-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099289671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000214833Medicaid