Healthcare Provider Details

I. General information

NPI: 1780480129
Provider Name (Legal Business Name): VEDANA WHOLE BEING THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 WALNUT ST STE 5
BOULDER CO
80302-5361
US

IV. Provider business mailing address

3020 JEFFERSON ST
BOULDER CO
80304-2638
US

V. Phone/Fax

Practice location:
  • Phone: 970-999-4979
  • 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:

VIII. Authorized Official

Name: STEPHANIE BROOKS
Title or Position: CEO
Credential: LPC
Phone: 303-957-7655