Healthcare Provider Details

I. General information

NPI: 1932236213
Provider Name (Legal Business Name): WILLIAM R BLEAU PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 W JEWELL AVE SUITE 251
LAKEWOOD CO
80228-4139
US

IV. Provider business mailing address

13701 W JEWELL AVE SUITE 251
LAKEWOOD CO
80228-4139
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-2129
  • Fax: 303-989-1362
Mailing address:
  • Phone: 303-989-2129
  • Fax: 303-989-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6311
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4183
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLB00074B
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCERTIFICATE 00038259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: