Healthcare Provider Details

I. General information

NPI: 1003533696
Provider Name (Legal Business Name): CATHRYN WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 BROADWAY STE 314C
BOULDER CO
80302-5233
US

IV. Provider business mailing address

1942 BROADWAY STE 314C
BOULDER CO
80302-5233
US

V. Phone/Fax

Practice location:
  • Phone: 720-663-0954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0019153
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: