Provider Demographics
NPI:1346600277
Name:BOULDER ADDICTIONS COUNSELING LLC
Entity type:Organization
Organization Name:BOULDER ADDICTIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC, LPC
Authorized Official - Phone:720-989-4987
Mailing Address - Street 1:1800 30TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1088
Mailing Address - Country:US
Mailing Address - Phone:424-646-3385
Mailing Address - Fax:
Practice Address - Street 1:1800 30TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1088
Practice Address - Country:US
Practice Address - Phone:424-646-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000346251S00000X
COLPC.0012761251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health