Healthcare Provider Details

I. General information

NPI: 1740429570
Provider Name (Legal Business Name): ALYSON SCHWABE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 IDYLWILD TRL SUITE 112
BOULDER CO
80301-3571
US

IV. Provider business mailing address

5412 IDYLWILD TRL SUITE 112
BOULDER CO
80301-3571
US

V. Phone/Fax

Practice location:
  • Phone: 303-960-7917
  • Fax: 303-530-1517
Mailing address:
  • Phone: 303-960-7917
  • Fax: 303-530-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: