Provider Demographics
NPI:1285273318
Name:WALMSLEY, JUSTIN BRENT (LAC, MFTC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRENT
Last Name:WALMSLEY
Suffix:
Gender:M
Credentials:LAC, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 30TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1071
Mailing Address - Country:US
Mailing Address - Phone:720-970-7752
Mailing Address - Fax:
Practice Address - Street 1:1790 30TH ST STE 350
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1071
Practice Address - Country:US
Practice Address - Phone:720-970-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014400106H00000X
COACD.0002505101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)