MEDICARE: WHOLE CONNECTION LLC

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	1041C0700X	Clinical Social Worker	#CSW.09923711	CO
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053868687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE CONNECTION LLC

Provider Business Mailing Address
First Line	:	100 ARAPAHOE AVE STE 14
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	720-442-0946
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ARAPAHOE AVE STE 14
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5862
Country	:	US
Telephone Number	:	720-316-7774
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	PHILLIP HORNER
Credential	:
Telephone Number	:	720-316-7774

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/30/2026

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Directions to “WHOLE CONNECTION LLC ” Practice Location

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