Healthcare Provider Details

I. General information

NPI: 1881613651
Provider Name (Legal Business Name): MICHAEL CARL JUST LPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28000 ROAD T
DOLORES CO
81323-9203
US

IV. Provider business mailing address

PO BOX 726
MANCOS CO
81328-0726
US

V. Phone/Fax

Practice location:
  • Phone: 970-882-1253
  • Fax: 970-882-1500
Mailing address:
  • Phone: 970-799-2303
  • Fax: 970-882-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number423
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: