Healthcare Provider Details

I. General information

NPI: 1053240176
Provider Name (Legal Business Name): MONIQUE VINCENT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2679 IRIS AVENUE OFFICE 107
BOULDER CO
80304
US

IV. Provider business mailing address

3055 29TH ST APT 102
BOULDER CO
80301-1323
US

V. Phone/Fax

Practice location:
  • Phone: 774-217-0359
  • Fax:
Mailing address:
  • Phone: 774-217-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE VINCENT
Title or Position: OWNER/COUNSELOR
Credential: MA, LAC, LPCC, NCC
Phone: 720-340-2722