Healthcare Provider Details

I. General information

NPI: 1730907015
Provider Name (Legal Business Name): OLIVER FRANKLIN MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 IRIS AVE STE 107
BOULDER CO
80304-4405
US

IV. Provider business mailing address

3120 CORONA TRL APT 310
BOULDER CO
80301-1438
US

V. Phone/Fax

Practice location:
  • Phone: 970-680-3607
  • Fax:
Mailing address:
  • Phone: 206-854-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22391
License Number StateCO

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: