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BOULDER WELLNESS PSYCHOLOGY, LLC AUTHORIZATION TO RELEASE PROTECTED HEALTH AND CONFIDENTIAL INFORMATION RELEASED FROM: NAME: ADDRESS: TELEPHONE: RELATIONSHIP TO CLIENT: RELEASED TO: NAME: ADDRESS:
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Boulder Wellness Psychology PLLC is a professional limited liability company that offers psychological wellness services in Boulder.
The owners or operators of Boulder Wellness Psychology PLLC are required to file the necessary paperwork with the appropriate regulatory agencies.
The owners or operators of Boulder Wellness Psychology PLLC must complete the required forms and submit them to the appropriate regulatory agencies.
The purpose of Boulder Wellness Psychology PLLC is to provide psychological wellness services to clients in the Boulder area.
The required information to be reported on Boulder Wellness Psychology PLLC includes financial statements, ownership information, and any relevant licensing or certification details.
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