Healthcare Provider Details

I. General information

NPI: 1962830620
Provider Name (Legal Business Name): STEPHANIE WILLIAMS LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE BOOCO

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4796 CHAMPLAIN DR
TIMNATH CO
80547-5845
US

IV. Provider business mailing address

4796 CHAMPLAIN DR
TIMNATH CO
80547-5845
US

V. Phone/Fax

Practice location:
  • Phone: 720-645-3373
  • Fax:
Mailing address:
  • Phone: 720-645-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12397
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number742
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: