Charlie Eliza Boutillette, LPC MA
Individual provider Active NPI Mental Health Counselor · Alamosa, CO
NPI 1508990086 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1508990086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 1725 (CO)
- Practice address
- 200 Ross Ave
Alamosa, CO 81101-2451 - Phone
- (719) 589-2786
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sondermind Provider Network LLC
Practice addresses (Care Compare)
720 S Colorado Blvd
PH North
Denver, CO 80246-1904
Phone (844) 843-7279
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240220003771 | CO | Practitioner - Mental Health Counselor | 5193169985 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Professional | Current |
Accepting new patients |
Locations
720 S Colorado Blvd
Ph N
Glendale, CO 80246
Phone (833) 988-0589
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1725 | CO | Yes |
Addresses
Primary practice location
200 Ross Ave
Alamosa, CO 81101-2451
Mailing address
200 Ross Ave
Alamosa, CO 81101-2451
Phone (719) 589-2786
Other providers in Alamosa, CO
- Nicole Bontrager
- Michael Patrick Borbely
- Rhonda Borders
- Alliyah Borjas
- Jennifer Boswell
- Wesley Brandon
- Svetlana Bresnitz
- William Brinton
- Amie Brooks
- Jennifer Brooks
All providers in Alamosa, CO · Mental Health Counselor in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.