Healthcare Provider Details

I. General information

NPI: 1558705384
Provider Name (Legal Business Name): EVE CHANTELLE BEILOVEI L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TINA JEAN BURNHAM

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MANHATTAN DR STE 100
BOULDER CO
80303-4251
US

IV. Provider business mailing address

5095 VALMONT RD APT A
BOULDER CO
80301-2764
US

V. Phone/Fax

Practice location:
  • Phone: 719-362-0778
  • Fax:
Mailing address:
  • Phone: 612-270-1358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0021382
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT3400292
License Number StateMN

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: