Healthcare Provider Details

I. General information

NPI: 1144985201
Provider Name (Legal Business Name): WOODSWALK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 VANCE DR STE 105
ARVADA CO
80003-2120
US

IV. Provider business mailing address

1601 29TH ST UNIT 1292
BOULDER CO
80301-1010
US

V. Phone/Fax

Practice location:
  • Phone: 720-288-0860
  • Fax: 303-479-7420
Mailing address:
  • Phone: 720-288-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME MYERSON
Title or Position: OWNER AND CLINICAL DIRECTOR
Credential: MA, LPC, NCC
Phone: 720-288-0033