Healthcare Provider Details

I. General information

NPI: 1548156748
Provider Name (Legal Business Name): SUN MI KIM LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 IRIS AVE
BOULDER CO
80301-2006
US

IV. Provider business mailing address

3665 IRIS AVE
BOULDER CO
80301-2006
US

V. Phone/Fax

Practice location:
  • Phone: 530-261-0677
  • Fax:
Mailing address:
  • Phone: 530-261-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: