Healthcare Provider Details

I. General information

NPI: 1013352483
Provider Name (Legal Business Name): MR. KIRK ROBERT YEAGER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 E JEWELL AVE APT 55
DENVER CO
80247-3540
US

IV. Provider business mailing address

4101 E LOUISIANA AVE STE 110
DENVER CO
80246-3456
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-0589
  • Fax:
Mailing address:
  • Phone: 720-504-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015236
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: