Healthcare Provider Details

I. General information

NPI: 1891069175
Provider Name (Legal Business Name): MOLLY OLK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 CENTER GREEN CT STE G212
BOULDER CO
80301-2359
US

IV. Provider business mailing address

1440 BLAKE ST SUITE 330
DENVER CO
80202-1474
US

V. Phone/Fax

Practice location:
  • Phone: 720-244-9884
  • Fax:
Mailing address:
  • Phone: 720-244-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11871
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: