Healthcare Provider Details

I. General information

NPI: 1942181730
Provider Name (Legal Business Name): JULIA ELLIS CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6662 GUNPARK DR
BOULDER CO
80301-3386
US

IV. Provider business mailing address

3357 RIDGE RD
NEDERLAND CO
80466-9711
US

V. Phone/Fax

Practice location:
  • Phone: 804-317-5603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023935
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: