Boulder Alcohol Education Center Inc

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Legal business name

BOULDER ALCOHOL EDUCATION CENTER INC

Practice address

1525 Spruce St Ste 100
Boulder, CO 80302-4256

Phone

(303) 444-6142

Fax

(303) 444-6177

NPI assigned

Jan 13, 2020

Organization subpart

No

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

Authorized official

Name

John O Gilburt, PHD, CAC III, LPSY

Title

Owner/Director

Phone

(720) 235-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward S. Marshall, PSY.D.

  • Clinical Psychologist
  • Thornton, CO
  • NPI 1982822581
  NPD (past)
• Loretta Miller, MA, LAC, LPC

  • Professional Counselor
  • Boulder, CO
  • NPI 1720574882
  NPD (past)

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1992345458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 SPRUCE ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803024256",
            "telephone_number": "303-444-6142",
            "fax_number": "303-444-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 SPRUCE ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803024256",
            "telephone_number": "303-444-6142",
            "fax_number": "303-444-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER ALCOHOL EDUCATION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-13",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "GILBURT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "720-235-7000",
        "authorized_official_credential": "PHD, CAC III, LPSY"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO OFFICE OF BEHAVIORAL HEALTH",
            "identifier": "1111-00",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Psychologist in Boulder, CO
• Providers in Boulder, CO by specialty
• Addiction (Substance Use Disorder) Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.