MEDICARE: CHANELLE MURO LMFT

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	101Y00000X	Counselor	MFT.0001483	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFT.0001483	OTHER	CO	COUNSELOR

General Provider Information

NPI Number	:	1861036477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE MURO LMFT

Provider Business Mailing Address
First Line	:	1465 KELLY JOHNSON BLVD STE 350
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 350
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3983
Country	:	US
Telephone Number	:	719-362-0796
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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