Healthcare Provider Details

I. General information

NPI: 1336653385
Provider Name (Legal Business Name): BOULDER JOURNEY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BUTTE ST LOT 25
BOULDER CO
80301-2236
US

IV. Provider business mailing address

5000 BUTTE ST LOT 25
BOULDER CO
80301-2236
US

V. Phone/Fax

Practice location:
  • Phone: 303-819-7393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberCSW.1059
License Number StateCO

VIII. Authorized Official

Name: MS. JEAN GEHRING
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW, CAC III
Phone: 303-819-7393