Provider Demographics
NPI:1912593310
Name:ELLIS, CAITLIN MICHELE WOLNIK (LPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MICHELE WOLNIK
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5541
Mailing Address - Country:US
Mailing Address - Phone:303-862-1529
Mailing Address - Fax:
Practice Address - Street 1:2801 YOUNGFIELD ST STE 300
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2265
Practice Address - Country:US
Practice Address - Phone:303-205-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional