=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992965693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH KRULL LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2008
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2465 S DOWNING ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-5774
-----------------------------------------------------
Fax | 303-778-3701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2465 S DOWNING ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80210-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-778-5774
-----------------------------------------------------
Fax | 303-778-3701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC904
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------