Healthcare Provider Details

I. General information

NPI: 1437195088
Provider Name (Legal Business Name): RICHARD RONALD BOERSMA M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LINCOLN AVE SUITE 2000
STEAMBOAT SPRINGS CO
80487-4972
US

IV. Provider business mailing address

810 LINCOLN AVENUE, SUITE 2000 P.O. BOX 770240
STEAMBOAT SPRINGS CO
80477-4444
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-7637
  • Fax: 970-871-6811
Mailing address:
  • Phone: 970-879-7637
  • Fax: 970-871-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: