Provider Demographics
NPI:1265666440
Name:ANKENMAN, ALICIA (MA, LPC, CADC1)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ANKENMAN
Suffix:
Gender:F
Credentials:MA, LPC, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1202
Mailing Address - Country:US
Mailing Address - Phone:541-444-0983
Mailing Address - Fax:
Practice Address - Street 1:2730 29TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1202
Practice Address - Country:US
Practice Address - Phone:541-444-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2975101YM0800X, 101YP2500X
101Y00000X, 101YA0400X
COLPC.0021596101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)