MEDICARE: STEVEN ROBERT DIETER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5542	CO

General Provider Information

NPI Number	:	1013614619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ROBERT DIETER LPC

Provider Business Mailing Address
First Line	:	13922 DENVER WEST PKWY STE 150
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3113
Country	:	US
Telephone Number	:	303-674-6681
Fax Number	:

Provider Business Practice Location Address
First Line	:	13922 DENVER WEST PKWY STE 150
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3113
Country	:	US
Telephone Number	:	303-674-6681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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