| Boulder Alcohol Education Center Inc | |
|
1525 Spruce St Ste 100 Boulder CO 80302-4256 | |
| (303) 444-6142 | |
| (303) 444-6177 |
| Full Name | Boulder Alcohol Education Center Inc |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 1525 Spruce St Ste 100, Boulder, Colorado |
| Authorized Official Name and Position | John O Gilburt (OWNER/DIRECTOR) |
| Authorized Official Contact | 7202357000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulder Alcohol Education Center Inc 1525 Spruce St Ste 100 Boulder CO 80302-4256 Ph: (303) 444-6142 | Boulder Alcohol Education Center Inc 1525 Spruce St Ste 100 Boulder CO 80302-4256 Ph: (303) 444-6142 |
| NPI Number | 1992345458 |
|---|---|
| Provider Enumeration Date | 01/13/2020 |
| Last Update Date | 01/13/2020 |
| Certification Date | 01/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992345458 | NPI | - | NPPES |
| 1111-00 | Other | CO | COLORADO OFFICE OF BEHAVIORAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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