Healthcare Provider Details

I. General information

NPI: 1487475786
Provider Name (Legal Business Name): WHOLE CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 MANHATTAN CIR STE 250
BOULDER CO
80303-8212
US

IV. Provider business mailing address

100 ARAPAHOE AVE STE 10
BOULDER CO
80302-5815
US

V. Phone/Fax

Practice location:
  • Phone: 720-442-0946
  • Fax: 720-590-6618
Mailing address:
  • Phone: 720-442-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP HORNER
Title or Position: DIRECTOR
Credential:
Phone: 720-316-7774