Healthcare Provider Details

I. General information

NPI: 1205460680
Provider Name (Legal Business Name): ALAINA BOSWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E YAMPA ST STE 4
COLORADO SPRINGS CO
80909-5061
US

IV. Provider business mailing address

4515 MOFFAT LN
COLORADO SPRINGS CO
80915-2701
US

V. Phone/Fax

Practice location:
  • Phone: 719-900-2079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: