Basic Information
| Provider Information | |||||||||
| NPI: | 1124244504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULDER COUNTY MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | WARNER HOUSE 2833BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2833 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | GEIST | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH WORKER | ||||||||
| AuthorizedOfficialTelephone: | 3034492217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 251S00000X | CO | Y | Agencies | Community/Behavioral Health |
No ID Information.