Healthcare Provider Details

I. General information

NPI: 1265666440
Provider Name (Legal Business Name): ALICIA ANKENMAN MA, LPC, SEP, BSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 29TH ST
BOULDER CO
80301-1202
US

IV. Provider business mailing address

2730 29TH ST
BOULDER CO
80301-1202
US

V. Phone/Fax

Practice location:
  • Phone: 541-444-0983
  • Fax:
Mailing address:
  • Phone: 541-444-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC2975
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0021596
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2975
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0021596
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: