| Prosopon | |
|
100 Arapahoe Ave Ste 9 Boulder CO 80302-5854 | |
| (303) 900-8378 | |
| Not Available |
| Full Name | Prosopon |
|---|---|
| Speciality | Counselor |
| Location | 100 Arapahoe Ave Ste 9, Boulder, Colorado |
| Authorized Official Name and Position | Elizabeth C Long (OWNER) |
| Authorized Official Contact | 5127735269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prosopon 100 Arapahoe Ave Ste 9 Boulder CO 80302-5854 Ph: (303) 900-8378 | Prosopon 100 Arapahoe Ave Ste 9 Boulder CO 80302-5854 Ph: (303) 900-8378 |
| NPI Number | 1184350019 |
|---|---|
| Provider Enumeration Date | 07/25/2022 |
| Last Update Date | 07/25/2022 |
| Certification Date | 07/25/2022 |
| Medicare PECOS PAC ID | 4981040151 |
|---|---|
| Medicare Enrollment ID | O20240311000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184350019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Elizabeth L Rottman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225636236 PECOS PAC ID: 5890131064 Enrollment ID: I20240311000546 |
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