Healthcare Provider Details

I. General information

NPI: 1386396620
Provider Name (Legal Business Name): DAKOTAH C ACOSTA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 BROADWAY ST
BOULDER CO
80304-4108
US

IV. Provider business mailing address

3250 ONEAL CIR APT F20
BOULDER CO
80301-1437
US

V. Phone/Fax

Practice location:
  • Phone: 720-739-6500
  • Fax:
Mailing address:
  • Phone: 602-301-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: