Healthcare Provider Details

I. General information

NPI: 1609201102
Provider Name (Legal Business Name): LAIA JORBA GALDOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST STE 201D
BOULDER CO
80301-1026
US

IV. Provider business mailing address

955 LARAMIE BLVD UNIT D
BOULDER CO
80304-4730
US

V. Phone/Fax

Practice location:
  • Phone: 303-663-8500
  • Fax:
Mailing address:
  • Phone:
  • 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:

# 1
Identifier9000149530
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: