Healthcare Provider Details

I. General information

NPI: 1669723235
Provider Name (Legal Business Name): LAUREN CALDWELL GREENWELL CAC I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAUREN CALDWELL

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 NORTH ST
BOULDER CO
80304-3279
US

IV. Provider business mailing address

975 NORTH ST
BOULDER CO
80304-3279
US

V. Phone/Fax

Practice location:
  • Phone: 303-413-6348
  • Fax:
Mailing address:
  • Phone: 303-413-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0007527
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: