=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912593310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN MICHELE WOLNIK ELLIS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2020
-----------------------------------------------------
Last Update Date | 12/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 YOUNGFIELD ST STE 300
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-205-8482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 HARRISON ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80206-5541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-862-1529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0016777
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------