Healthcare Provider Details

I. General information

NPI: 1609795913
Provider Name (Legal Business Name): ELLEN TUOHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAXWELL AVE
BOULDER CO
80304-3940
US

IV. Provider business mailing address

623 MAXWELL AVE
BOULDER CO
80304-3940
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-7119
  • Fax:
Mailing address:
  • Phone: 720-679-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0024142
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: