Provider Demographics
NPI:1104458603
Name:BOUNDLESS COMPASSION LLC
Entity type:Organization
Organization Name:BOUNDLESS COMPASSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEWALT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-685-6473
Mailing Address - Street 1:2393 STEPPING STONES WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2772
Mailing Address - Country:US
Mailing Address - Phone:719-685-6473
Mailing Address - Fax:
Practice Address - Street 1:2611 W COLORADO AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3076
Practice Address - Country:US
Practice Address - Phone:719-445-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty