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General NPI Number Information
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NPI Number | 1730488594
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Entity Type | Individual
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Provider Name | JOHN RICHARD STAUTER M.A., L.P.C., N.C.C.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2011
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 17210 PROSPECTOR DR PEYTON
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City | PEYTON
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State | CO
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Zip | 80831-9375
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Country | US
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Telephone | 719-749-0075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13 PEYTON
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City | PEYTON
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State | CO
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Zip | 80831-0013
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Country | US
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Telephone | 719-749-0075
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4706
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License Number State | CO
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