Healthcare Provider Details

I. General information

NPI: 1437880200
Provider Name (Legal Business Name): UMBRELLA COLLECTIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 SPRUCE STREET
BOULDER CO
80302-4814
US

IV. Provider business mailing address

2919 VALMONT ROAD SUITE 104
BOULDER CO
80301-1350
US

V. Phone/Fax

Practice location:
  • Phone: 720-663-0163
  • Fax: 303-658-9871
Mailing address:
  • Phone: 720-663-0163
  • Fax: 303-658-9871

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: LI BROOKENS
Title or Position: OWNER
Credential: LCSW
Phone: 720-663-0163