MR. SAMUEL WIDD MEDFORD JR. (NPI# 1346324530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346324530 |
| Entity Type | Individual |
| Full Name | MR. SAMUEL WIDD MEDFORD JR. |
| Credential | LMFT |
| Practice Address |
3450 Broadway St Boulder CO 80304-1824 |
| Mailing Address |
3450 Broadway Boulder CO 80304-1899 |
| Practice Telephone | 3034411100 |
| Mailing Telephone | 3034411100 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-07-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
ACB-6412 | CO | Behavioral Health & Social Service Providers |
| Y | 106H00000X | Marriage & Family Therapist | 713 | CO | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 46454080 | 05 |
| Street Address |
3450 BROADWAY ST |
| City | BOULDER |
| State | CO |
| Zip Code | 80304-1824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881002574 | Catherine Ruth Abel | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-26 |
| 1962819797 | Judith Anne Voorhees Brown | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-14 |
| 1134535420 | Michele Ryan | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-08 |
| 1558777144 | Paul Egan Jr. | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-03 |
| 1114333796 | Michael Mack | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-03 |
| 1124434774 | Natasha Stackhouse | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-03 |
| 1588070361 | James Mcmillan | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-07-01 |
| 1366857120 | Abby Hulser | Community/Behavioral Health | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-06-30 |
| 1487069357 | Patrick Leonard Jeter | Counselor | 3450 Broadway St, Boulder, CO 80304-1899 | 2014-06-30 |
| 1477968469 | Karen Tracy | Counselor | 3450 Broadway St, Boulder, CO 80304-1824 | 2014-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720605256 | Evol.v Chiropractic LLC | Chiropractor | 2401 Broadway #208, Boulder, CO 80304 | 2020-07-01 |
| 1760038723 | Patrica Anne Zeyher | Counselor | 100 Alpine Ave., Boulder, CO 80304 | 2019-08-15 |
| 1356855928 | Opal Counseling Center, LLC | Counselor | 1480 Lee Hill Dr. #7, Boulder, CO 80304 | 2017-11-19 |
| 1831608603 | Lesley Ann Cloke | Dietitian, Registered | 1895 Bluff St., Unit C, Boulder, CO 80304 | 2017-09-25 |
| 1790209740 | Megan Litwiller | Occupational Therapist | 810 Maxwell Ave, Boulder, CO 80304 | 2017-08-01 |
| 1285163774 | Nadine Martin | Registered Nurse | 311 Mapleton Ave # 331, Boulder, CO 80304 | 2017-06-08 |
| 1598119281 | Megan Cronin Larson | Social Worker | 825 S. Broadway Street, Boulder, CO 80304 | 2016-04-19 |
| 1760844237 | Rafia Rebeck | Counselor | 1235 Elder Ave #7, Boulder, CO 80304 | 2016-03-24 |
| 1629441688 | Jennifer S Delaney | Counselor | 2334 Broadway, Ste. B, Boulder, CO 80304 | 2015-11-12 |
| 1891162301 | Kingston Dialysis LLC | Clinic/Center | 2880 Folsom St Ste 110, Boulder, CO 80304 | 2015-09-01 |
| Find all providers in zip 80304 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134673635 | Timothy Milner | Marriage & Family Therapist | 3393 Iris Ave Ste 106-1, Boulder, CO 80301-5205 | 2016-08-12 |
| 1376995373 | Anne Weatherley | Marriage & Family Therapist | 325 Colgate St, Boulder, CO 80305-5356 | 2016-07-01 |
| 1104235779 | Joyce Larson | Marriage & Family Therapist | 1190 S Lashley Ln, Boulder, CO 80305 | 2014-08-07 |
| 1487073847 | Pursuits Coaching and Psychotherapy | Marriage & Family Therapist | 3106 Galileo Ln, Boulder, CO 80301-5463 | 2014-04-15 |
| 1033540018 | Trina Renee Brown | Marriage & Family Therapist | 2825 Marine St Ste 203, Boulder, CO 80303-1027 | 2013-12-02 |
| 1538443106 | Maura Leigh Lohrentz | Marriage & Family Therapist | 85 S 38th St, Boulder, CO 80305-5501 | 2011-09-30 |
| 1194018044 | Tamra Sattler | Marriage & Family Therapist | 3050 Broadway St Ste 300, Boulder, CO 80304 | 2011-05-25 |
| 1912232612 | Nyle Biondi | Marriage & Family Therapist | 1800 30th St Ste 304, Boulder, CO 80301-1026 | 2009-10-14 |
| 1992950331 | Debora Taylor Ross | Marriage & Family Therapist | 912 Grant Pl, Boulder, CO 80302-7117 | 2008-11-26 |
| 1174739296 | Isabelle Tierney | Marriage & Family Therapist | 2291 Arapahoe Ave, Boulder, CO 80302-6603 | 2007-05-15 |
| Find all providers in BOULDER | ||||
Please comment or provide details below to improve the information on MR. SAMUEL WIDD MEDFORD JR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.