Provider Demographics
NPI:1730576844
Name:FOUR CORNERS NATUROPATHIC
Entity type:Organization
Organization Name:FOUR CORNERS NATUROPATHIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ND LPC RN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-799-8961
Mailing Address - Street 1:545 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4335
Mailing Address - Country:US
Mailing Address - Phone:970-799-8961
Mailing Address - Fax:
Practice Address - Street 1:48 COUNTY ROAD 250 UNIT 7
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8848
Practice Address - Country:US
Practice Address - Phone:970-799-8961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0171869163W00000X
CO0000026175F00000X
CO0012355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty