Individual
EVAN PROULX BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2625 REDWING RD STE 175, FORT COLLINS, CO 80526-6324
(970) 363-6651
Mailing address
PO BOX 1112, FORT COLLINS, CO 80522-1112
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPCC.0019543
CO
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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