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General NPI Number Information
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NPI Number | 1578163093
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Entity Type | Individual
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Provider Name | TRAEMON MCCABE LPC, LAC
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 06/09/2024
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Provider Practice Location Address
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Address Line | 507 E ROUTT AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2352
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Country | US
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Telephone | 719-320-5239
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Fax |
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Provider Business Mailing Address
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Address Line | 507 E ROUTT AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2352
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0002202
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0020160
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License Number State | CO
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