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4770 Baseline Rd Ste 200 Boulder CO 80303-2668 | |
| (720) 893-0842 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4770 Baseline Rd Ste 200, Boulder, Colorado |
| Authorized Official Name and Position | Joseph Yeretsian (PRESIDENT) |
| Authorized Official Contact | 6175071472 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4770 Baseline Rd 2nd Floor Boulder CO 80303-2666 Ph: (720) 893-0842 | 4770 Baseline Rd Ste 200 Boulder CO 80303-2668 Ph: (720) 893-0842 |
| NPI Number | 1942668165 |
|---|---|
| Provider Enumeration Date | 02/02/2016 |
| Last Update Date | 01/02/2020 |
| Certification Date | 01/02/2020 |
| Medicare PECOS PAC ID | 5597893313 |
|---|---|
| Medicare Enrollment ID | O20200318000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942668165 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | DR.0056212 (Colorado) | Primary |
| Provider Name | Joseph Yeretsian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003070210 PECOS PAC ID: 6002944824 Enrollment ID: I20200318000785 |
| Provider Name | Shanin Rae Vowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306434857 PECOS PAC ID: 0042628398 Enrollment ID: I20210426002495 |
| Provider Name | Alex Joshua Betz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952905929 PECOS PAC ID: 0244634624 Enrollment ID: I20210806001380 |
| Provider Name | Alyssa Gosselin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427775980 PECOS PAC ID: 3375915945 Enrollment ID: I20230207003547 |
| Provider Name | Julie Marie Bass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083167019 PECOS PAC ID: 0941673388 Enrollment ID: I20230306000388 |
| Provider Name | Rebekah Bullock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285168344 PECOS PAC ID: 2567730153 Enrollment ID: I20230320000569 |
| Provider Name | Melody Bourret |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548926488 PECOS PAC ID: 1850753914 Enrollment ID: I20230822000901 |
| Provider Name | Kelsey Nicole Froom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487388435 PECOS PAC ID: 1557738804 Enrollment ID: I20231211001943 |
| Provider Name | Rebecca E Robitaille |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154194199 PECOS PAC ID: 2365885191 Enrollment ID: I20240208003855 |
| Provider Name | Reid Hoffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922875566 PECOS PAC ID: 5597106286 Enrollment ID: I20240513001709 |
| Provider Name | Rainisha La Verne Barton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730564485 PECOS PAC ID: 5496295537 Enrollment ID: I20240904002568 |
| Provider Name | Brian Keith Boles |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912376575 PECOS PAC ID: 3274073143 Enrollment ID: I20240905003763 |
| Provider Name | Lisa Marie Cruz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619547510 PECOS PAC ID: 4789124629 Enrollment ID: I20240906001308 |
| Provider Name | Christina M Deas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356061162 PECOS PAC ID: 4981144748 Enrollment ID: I20240906002507 |
| Provider Name | Christine Jeanne Wolf |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649822602 PECOS PAC ID: 9133660749 Enrollment ID: I20240924000106 |
Ben Cohen, Ph.d., P.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1634 Walnut St, Suite 221, Boulder, CO 80302 Phone: 303-717-5651 | |
Lookout Managment Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6901 Lookout Rd, Boulder, CO 80301 Phone: 303-443-7695 | |
Eileen Purdy Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1200 28th St Street, Boulder, CO 80303 Phone: 503-320-0334 | |
Center For Valued Living Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2955 Valmont Rd Ste 230, Boulder, CO 80301 Phone: 720-347-8559 | |
Liz Maher, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 6680 Gunpark Dr, Boulder, CO 80301 Phone: 415-513-9016 | |
Jla Medical Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 Canyon Blvd, Suite 300, Boulder, CO 80302 Phone: 303-449-7541 |