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General NPI Number Information
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NPI Number | 1942105903
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Entity Type | Organization
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Legal Business Name | JO LYNN PARK, PLLC
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 4717 SPINE RD APT A
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City | BOULDER
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State | CO
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Zip | 80301-5341
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Country | US
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Telephone | 970-759-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 SPINE RD APT A
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City | BOULDER
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State | CO
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Zip | 80301-5341
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Country | US
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Telephone | 970-759-8227
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JO LYNN PARK
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Credential | LPC
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Telephone | 970-759-8227
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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 |
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License Number State | NULL
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