Provider Demographics
NPI:1386396620
Name:ACOSTA, DAKOTAH C (MA)
Entity type:Individual
Prefix:
First Name:DAKOTAH
Middle Name:C
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 ONEAL CIR APT F20
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1437
Mailing Address - Country:US
Mailing Address - Phone:602-301-3828
Mailing Address - Fax:
Practice Address - Street 1:2429 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4108
Practice Address - Country:US
Practice Address - Phone:720-739-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist