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General NPI Number Information
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NPI Number | 1841789526
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Entity Type | Organization
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Legal Business Name | GENESA FALCAO PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 1800 30TH ST STE 207
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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 | 720-582-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 4965 TWIN LAKES RD APT 72
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City | BOULDER
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State | CO
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Zip | 80301-3892
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Country | US
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Telephone | 301-221-4472
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Fax | 833-575-7126
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Authorized Official
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Title or Position | LPC
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Name | GENESA FALCAO
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Credential | LPC
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Telephone | 301-221-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0012470
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License Number State | CO
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