Healthcare Provider Details

I. General information

NPI: 1104613462
Provider Name (Legal Business Name): FULL CIRCLE WHOLENESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

IV. Provider business mailing address

1650 38TH ST STE 100E
BOULDER CO
80301-2624
US

V. Phone/Fax

Practice location:
  • Phone: 720-784-5222
  • Fax:
Mailing address:
  • Phone: 720-784-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEVIN LAFFERTY
Title or Position: COUNSELOR, ART THERAPIST
Credential: LPC, ATR-P
Phone: 720-784-5222