Individual
ALEXIS MITSUKO KAMAKANOE ORNELLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LAC
Contact information
Practice address
2635 MAPLETON AVE LOT 24, BOULDER, CO 80304-3828
(720) 408-5393
Mailing address
2635 MAPLETON AVE LOT 24, BOULDER, CO 80304-3828
(720) 408-5393
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0000422
CO
101YM0800X
Mental Health Counselor
Primary
LPC.0012209
CO
Other
Enumeration date
06/23/2014
Last updated
11/25/2014
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