Healthcare Provider Details

I. General information

NPI: 1093908139
Provider Name (Legal Business Name): MICHEAL KEHL ACSW LCSW MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 ROBERTSON ST
FORT COLLINS CO
80524
US

IV. Provider business mailing address

1037 ROBERTSON ST
FORT COLLINS CO
80524
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-3833
  • Fax: 970-493-4333
Mailing address:
  • Phone: 970-493-3833
  • Fax: 970-493-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number982037
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: