Healthcare Provider Details

I. General information

NPI: 1083428064
Provider Name (Legal Business Name): WILD ROSE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 ARAPAHOE AVE STE 203
BOULDER CO
80303-1044
US

IV. Provider business mailing address

4516 STARBOARD CT
BOULDER CO
80301-3127
US

V. Phone/Fax

Practice location:
  • Phone: 303-834-7380
  • Fax:
Mailing address:
  • Phone: 303-834-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE ROSE RICHARDS-SHRESTHA
Title or Position: PSYCHOTHERAPIST AND OWNER
Credential: MA, LPC
Phone: 303-834-7380