Healthcare Provider Details

I. General information

NPI: 1013641471
Provider Name (Legal Business Name): RAINBOW FLAME COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 PEARL EAST CIR STE 118 PMB 68698
BOULDER CO
80301-6112
US

IV. Provider business mailing address

4845 PEARL EAST CIR STE 118 PMB 68698
BOULDER CO
80301-6112
US

V. Phone/Fax

Practice location:
  • Phone: 720-365-4497
  • Fax:
Mailing address:
  • Phone: 720-365-4497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social 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: VICTORIA SPENSER-NICHOLAS GREY
Title or Position: CORE DIRECTOR
Credential: LCSW
Phone: 720-365-4497