Provider Demographics
NPI:1932853181
Name:BOULDER WELLNESS COUNSELING, PLLC
Entity Type:Organization
Organization Name:BOULDER WELLNESS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:402-990-8287
Mailing Address - Street 1:6525 GUNPARK DR STE 370-274
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3346
Mailing Address - Country:US
Mailing Address - Phone:720-432-7787
Mailing Address - Fax:
Practice Address - Street 1:6525 GUNPARK DR STE 370-274
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3346
Practice Address - Country:US
Practice Address - Phone:720-432-7787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health