=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528708864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDSEY WILKINSON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2022
-----------------------------------------------------
Last Update Date | 04/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 S BROADWAY ST STE 12
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80305-5932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-817-5540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3482
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80466-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-817-5540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LINDSEY WILKINSON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 303-817-5540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------