Healthcare Provider Details

I. General information

NPI: 1104737600
Provider Name (Legal Business Name): INFINITE SELF COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CANYON BLVD STE D
BOULDER CO
80302-5125
US

IV. Provider business mailing address

807 HAYS CIR
LONGMONT CO
80504-1345
US

V. Phone/Fax

Practice location:
  • Phone: 303-949-3636
  • Fax:
Mailing address:
  • Phone: 303-949-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI ELIZABETH ALLEN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 303-949-3636