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 |
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Provider Enumeration Date | 07/25/2022 |
Last Update Date | 07/25/2022 |
Certification Date | 07/25/2022 |
Medicare PECOS PAC ID | 4981040151 |
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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 |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1225636236 PECOS PAC ID: 5890131064 Enrollment ID: I20240311000546 |
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