Healthcare Provider Details

I. General information

NPI: 1770814758
Provider Name (Legal Business Name): CLYDE S ALTUM M.A., LPC, CACII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S BLACKHAWK ST STE 160
AURORA CO
80014-1476
US

IV. Provider business mailing address

3287 95TH ST
BOULDER CO
80301-4935
US

V. Phone/Fax

Practice location:
  • Phone: 720-297-2063
  • Fax:
Mailing address:
  • Phone: 720-297-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9681
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: