Healthcare Provider Details

I. General information

NPI: 1053239392
Provider Name (Legal Business Name): JAMES AGATI JR. LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 TABLE MESA DR # C-100
BOULDER CO
80305-5560
US

IV. Provider business mailing address

4730 TABLE MESA DR # C-100
BOULDER CO
80305-5560
US

V. Phone/Fax

Practice location:
  • Phone: 720-893-0680
  • Fax:
Mailing address:
  • Phone: 720-893-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0024983
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: