=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043823081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEAL CENTER FOR COUNSELING AND YOGA THERAPIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 03/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 826 S VANCE ST UNIT C
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-257-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 826 S VANCE ST UNIT C
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80226-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-257-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | CHARLES ANDREW NEAL
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 720-257-9097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------