| Autumn Tree Therapy | |
|
2935 Baseline Rd Ste. 302 Boulder CO 80303-2366 | |
| (303) 875-2364 | |
| Not Available |
| Full Name | Autumn Tree Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 2935 Baseline Rd, Boulder, Colorado |
| Authorized Official Name and Position | Carley Cohen-fox (CLINICIAN/OWNER) |
| Authorized Official Contact | 3038752364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Tree Therapy 2935 Baseline Rd Ste. 302 Boulder CO 80303-2366 Ph: (303) 875-2364 | Autumn Tree Therapy 2935 Baseline Rd Ste. 302 Boulder CO 80303-2366 Ph: (303) 875-2364 |
| NPI Number | 1750812889 |
|---|---|
| Provider Enumeration Date | 03/21/2017 |
| Last Update Date | 03/21/2017 |
| Medicare PECOS PAC ID | 2365728490 |
|---|---|
| Medicare Enrollment ID | O20170404000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750812889 | NPI | - | NPPES |
| 54105081 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 727 (Colorado) | Primary |
| Provider Name | Carley A Cohen-fox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053644922 PECOS PAC ID: 1658410592 Enrollment ID: I20091205000135 |
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