Healthcare Provider Details

I. General information

NPI: 1417961301
Provider Name (Legal Business Name): JULIE A KINTZING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BROADWAY ST STE 5
BOULDER CO
80302-5266
US

IV. Provider business mailing address

PO BOX 20944
BOULDER CO
80308-3944
US

V. Phone/Fax

Practice location:
  • Phone: 303-875-6207
  • Fax:
Mailing address:
  • Phone: 303-875-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number991657
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: