Healthcare Provider Details

I. General information

NPI: 1285457549
Provider Name (Legal Business Name): HOLLY TRIENENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 30TH ST
BOULDER CO
80305-3319
US

IV. Provider business mailing address

245 30TH ST
BOULDER CO
80305-3319
US

V. Phone/Fax

Practice location:
  • Phone: 847-445-2757
  • Fax:
Mailing address:
  • Phone: 847-445-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0021456
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: