Mark Anthony Dewolf, MA, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC.0015925 Issued in CO

Practice address

3333 Iris Ave Ste 210
Boulder, CO 80301-1998

Phone

(970) 470-1240

NPI assigned

Jun 15, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mahadev Anthony Dewolf Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Authentic Self LLC

  • Mental Health Counselor
  • Boulder, CO
  • NPI 1548176126
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1356791834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8050 NIWOT RD APT 3",
            "city": "NIWOT",
            "state": "CO",
            "postal_code": "805038690",
            "telephone_number": "970-470-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 IRIS AVE STE 210",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011998",
            "telephone_number": "970-470-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWOLF",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "MA, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0015925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAHADEV",
            "last_name": "DEWOLF",
            "middle_name": "ANTHONY",
            "credential": "MA, LPC, NCC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Anne Devereux
• Paula Devillier, LMT
• James F. Dewey, M.ED.
• Madison Nicole Dewey, OTD, OTR/L
• Joshua W. Dewitt
• Avninder S Dhaliwal, MD
• Kristy Dhaliwal, D.D.S.
• Maria Grazia Di Giorgio, MA, LPC
• Victoria Dial
• Scott Diamond

• Professional Counselor in Boulder, CO
• Providers in Boulder, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.