MEDICARE: DENVER BOULDER COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053044180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER BOULDER COUNSELING PLLC

Provider Business Mailing Address
First Line	:	287 CENTURY CIR STE 100D
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1684
Country	:	US
Telephone Number	:	720-295-0578
Fax Number	:

Provider Business Practice Location Address
First Line	:	287 CENTURY CIR STE 100D
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1684
Country	:	US
Telephone Number	:	720-295-0578
Fax Number	:

Authorized Official
Title or Position	:	OWNERE
Name	:	KELLY SHAUGHNESSY
Credential	:	LPCC
Telephone Number	:	303-999-5828

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	07/06/2022

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