Healthcare Provider Details

I. General information

NPI: 1710607031
Provider Name (Legal Business Name): BOULDER NEUROPSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 30TH ST
BOULDER CO
80301-1088
US

IV. Provider business mailing address

PO BOX 1056
BOULDER CO
80306-1056
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-2553
  • Fax: 303-515-6499
Mailing address:
  • Phone: 510-908-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TOBIN JOSHUA HAAS
Title or Position: OWNER
Credential:
Phone: 510-908-0980