Healthcare Provider Details

I. General information

NPI: 1174298954
Provider Name (Legal Business Name): ALTITUDE WELLNESS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6662 GUNPARK DR STE 101
BOULDER CO
80301-3386
US

IV. Provider business mailing address

6662 GUNPARK DR STE 101
BOULDER CO
80301-3386
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-3702
  • Fax:
Mailing address:
  • Phone: 509-868-3702
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY DEPLEDGE
Title or Position: SOCIAL WORK
Credential: LCSW
Phone: 509-868-3702