Healthcare Provider Details

I. General information

NPI: 1033020342
Provider Name (Legal Business Name): BISON CIRCLE COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 33RD ST
BOULDER CO
80305-3423
US

IV. Provider business mailing address

1500 N GRANT ST # 11592
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 720-235-8036
  • Fax:
Mailing address:
  • Phone: 720-235-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: RAYL SMITH
Title or Position: MANAGING MEMBER
Credential: MS, BCBA
Phone: 541-941-4392