Healthcare Provider Details

I. General information

NPI: 1538580261
Provider Name (Legal Business Name): NATSUMI MINAGAWA PSY.D., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2013
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST STE 308
BOULDER CO
80301-1026
US

IV. Provider business mailing address

PO BOX 18904
BOULDER CO
80308-1904
US

V. Phone/Fax

Practice location:
  • Phone: 303-817-9057
  • Fax:
Mailing address:
  • Phone: 303-817-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6621
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number907
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5219
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4530
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: