NPIMap

Organization Active NPI

Boundless Potential, LLC

  • Behavior Analyst
  • Fountain, CO
National Provider Identifier
1487043980
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
11416922
Legal business name
BOUNDLESS POTENTIAL, LLC
Practice address
926 Square Dance LN
Fountain, CO 80817-4160
Phone
(325) 338-6182
NPI assigned
Jan 21, 2015
Last updated
Jan 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Authorized official

Name
Tiffany Rose Menzel, BCBANPI 1962890590
Title
Owner
Phone
(325) 338-6182

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X 11416922 Primary

Addresses

Primary practice location

926 Square Dance LN
Fountain, CO 80817-4160

Mailing address

926 Square Dance LN
Fountain, CO 80817-4160
Phone (325) 338-6182

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1487043980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 SQUARE DANCE LN",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808174160",
            "telephone_number": "325-338-6182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 SQUARE DANCE LN",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808174160",
            "telephone_number": "325-338-6182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDLESS POTENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "MENZEL",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "325-338-6182",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "11416922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.