Healthcare Provider Details

I. General information

NPI: 1558934349
Provider Name (Legal Business Name): WELLTALK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 11TH ST
BOULDER CO
80302-5101
US

IV. Provider business mailing address

2855 ROCK CREEK CIR UNIT 179
SUPERIOR CO
80027-4616
US

V. Phone/Fax

Practice location:
  • Phone: 720-210-9534
  • Fax:
Mailing address:
  • Phone: 415-254-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
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: CHRISTY WELLER
Title or Position: OWNER
Credential: PSY.D.
Phone: 720-210-9534