Healthcare Provider Details

I. General information

NPI: 1538441803
Provider Name (Legal Business Name): JAMES N. PETRI M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 MARTIN DR STE A
BOULDER CO
80305-6003
US

IV. Provider business mailing address

4535 MARTIN DR STE A
BOULDER CO
80305-6003
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-5319
  • Fax:
Mailing address:
  • Phone: 303-494-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002
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: