Provider Demographics
NPI: | 1619324696 |
---|---|
Name: | RICHARD J STEELE |
Entity type: | Organization |
Organization Name: | RICHARD J STEELE |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEELE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 832-443-9892 |
Mailing Address - Street 1: | 2635 MAPLETON AVE |
Mailing Address - Street 2: | APT 24 |
Mailing Address - City: | BOULDER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80304-3824 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-443-9892 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 720 KIPLING ST |
Practice Address - Street 2: | SUITE 17 |
Practice Address - City: | LAKEWOOD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80215-8003 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-443-9892 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-19 |
Last Update Date: | 2016-11-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 0005652 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |