Healthcare Provider Details

I. General information

NPI: 1770298929
Provider Name (Legal Business Name): LAURIE BOYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JENKINS RANCH RD UNIT E6
DURANGO CO
81301-9473
US

IV. Provider business mailing address

3045 E 2ND AVE APT A
DURANGO CO
81301-4270
US

V. Phone/Fax

Practice location:
  • Phone: 970-551-6155
  • Fax:
Mailing address:
  • Phone: 303-523-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928967
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier9000214833
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: