# BOULDER ALCOHOL EDUCATION CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992345458
- **Authorized official:** JOHN O GILBURT PHD, CAC III, LPSY (OWNER/DIRECTOR)
- **Authorized official phone:** (720) 235-7000

## Contact information

- **Practice address:** 1525 SPRUCE ST STE 100, BOULDER, CO 80302-4256
- **Practice address phone:** (303) 444-6142
- **Practice address fax:** (303) 444-6177
- **Mailing address:** 1525 SPRUCE ST STE 100, BOULDER, CO 80302-4256
- **Mailing address phone:** (303) 444-6142
- **Mailing address fax:** (303) 444-6177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | Yes |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2020
- **Last updated:** 01/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1111-00 | COLORADO OFFICE OF BEHAVIORAL HEALTH | CO |