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General NPI Number Information
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NPI Number | 1205799236
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Entity Type | Organization
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Legal Business Name | PROSOCIAL, LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1650 38TH ST STE 100E
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City | BOULDER
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State | CO
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Zip | 80301-2624
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Country | US
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Telephone | 720-310-5512
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 COLORADO AVE UNIT B
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City | BOULDER
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State | CO
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Zip | 80303-2102
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Country | US
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Telephone | 720-310-5512
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | LYDIA MATHIS
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Credential | LPC
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Telephone | 937-999-8374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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