Healthcare Provider Details

I. General information

NPI: 1922979244
Provider Name (Legal Business Name): BOULDER PRIDE DBA ROCKY MOUNTAIN EQUALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 MITCHELL LN
BOULDER CO
80301-2273
US

IV. Provider business mailing address

PO BOX 1018
BOULDER CO
80306-1018
US

V. Phone/Fax

Practice location:
  • Phone: 720-680-7383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: TAMORA TANNIEHILL
Title or Position: OWNER
Credential:
Phone: 720-680-7383