MEDICARE: OTOUPAL 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1134752439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTOUPAL COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	1341 EVERGREEN HEIGHTS DR
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-3333
Country	:	US
Telephone Number	:	719-501-3337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 EVERGREEN HEIGHTS DR
Second Line	:
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-3333
Country	:	US
Telephone Number	:	719-501-3337
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	NAN OTOUPAL
Credential	:	LCSW
Telephone Number	:	719-501-3337

Provider Enumeration Date	:	02/15/2020
Last Update Date	:	01/13/2023

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