Organization
BOULDER ALCOHOL EDUCATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN O GILBURT PHD, CAC III, LPSY (OWNER/DIRECTOR)
(720) 235-7000
Entity
Organization
Contact information
Practice address
1525 SPRUCE ST STE 100, BOULDER, CO 80302-4256
(303) 444-6142
(303) 444-6177
Mailing address
1525 SPRUCE ST STE 100, BOULDER, CO 80302-4256
(303) 444-6142
(303) 444-6177
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1111-00
COLORADO OFFICE OF BEHAVIORAL HEALTH
CO
Enumeration date
01/13/2020
Last updated
01/13/2020
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