| The Other Therapy Online, Llc | |
|
1650 38th St Ste 100e Boulder CO 80301-2624 | |
| (970) 319-7190 | |
| Not Available |
| Full Name | The Other Therapy Online, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1650 38th St Ste 100e, Boulder, Colorado |
| Authorized Official Name and Position | Trevor Brown (CEO) |
| Authorized Official Contact | 9703197190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Other Therapy Online, Llc 53 Cherry Ln Basalt CO 81621-9102 Ph: (970) 319-7190 | The Other Therapy Online, Llc 1650 38th St Ste 100e Boulder CO 80301-2624 Ph: (970) 319-7190 |
| NPI Number | 1063192276 |
|---|---|
| Provider Enumeration Date | 07/21/2023 |
| Last Update Date | 07/21/2023 |
| Certification Date | 07/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063192276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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