Healthcare Provider Details

I. General information

NPI: 1245917251
Provider Name (Legal Business Name): WHOLLY HEALING THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PEARL ST STE 315
BOULDER CO
80302-5130
US

IV. Provider business mailing address

1035 PEARL ST STE 315
BOULDER CO
80302-5130
US

V. Phone/Fax

Practice location:
  • Phone: 570-899-5038
  • Fax:
Mailing address:
  • Phone: 570-899-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIONNA MURRAY
Title or Position: OWNER
Credential: LCSW
Phone: 570-899-5038