MEDICARE: RICHARD J STEELE

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	101YP2500X	Professional Counselor	0005652	CO

General Provider Information

NPI Number	:	1760836159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J STEELE

Provider Business Mailing Address
First Line	:	2635 MAPLETON AVE
Second Line	:	UNIT 24
City	:	BOULDER
State	:	CO
Zip	:	80304-3824
Country	:	US
Telephone Number	:	832-443-9892
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 FOLSOM ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-2838
Country	:	US
Telephone Number	:	832-443-9892
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD J STEELE
Credential	:	LPC
Telephone Number	:	832-443-9892

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	11/04/2016

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