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General NPI Number Information
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NPI Number | 1609125491
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Entity Type | Individual
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Provider Name | MANUEL GOMEZ SOLERA MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 1455 DIXON AVE STE 300
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City | LAFAYETTE
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State | CO
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Zip | 80026-8880
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Country | US
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Telephone | 303-443-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 30TH ST STE 304
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City | BOULDER
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State | CO
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Zip | 80301-1026
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Country | US
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Telephone | 720-772-6604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0015018
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License Number State | CO
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