Individual
SHANE WACHLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3445 PENROSE PL STE 210, BOULDER, CO 80301-1874
(720) 319-7404
Mailing address
3935 DARLEY AVE, BOULDER, CO 80305-6518
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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