Provider Demographics
NPI:1730488594
Name:STAUTER, JOHN RICHARD (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:STAUTER
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:PEYTON
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-0013
Mailing Address - Country:US
Mailing Address - Phone:719-749-0075
Mailing Address - Fax:
Practice Address - Street 1:17210 PROSPECTOR DR
Practice Address - Street 2:PEYTON
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-9375
Practice Address - Country:US
Practice Address - Phone:719-749-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional