Healthcare Provider Details

I. General information

NPI: 1609624600
Provider Name (Legal Business Name): ROOTS OF POSSIBILITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 BROADWAY STE 314C
BOULDER CO
80302-5233
US

IV. Provider business mailing address

3861 S SHERMAN ST
ENGLEWOOD CO
80113-3717
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-2413
  • Fax:
Mailing address:
  • Phone: 303-263-3530
  • 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: JULIA KUTTLER
Title or Position: OWNER AND THERAPIST
Credential: MSW, LCSW
Phone: 303-263-3530