Healthcare Provider Details

I. General information

NPI: 1902308968
Provider Name (Legal Business Name): COURTNEY RAE LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY RAE THOMS MSW

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date: 05/19/2022
Reactivation Date: 07/07/2022

III. Provider practice location address

2919 VALMONT RD STE 104
BOULDER CO
80301-1350
US

IV. Provider business mailing address

2919 VALMONT RD STE 104
BOULDER CO
80301-1350
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930272
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: