Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP2500X | Professional Counselor | LPC.0017779 | CO |
NPI | 1003453937 |
---|---|
Provider Name | Justin M Billot |
First Address | Colorado Springs, CO 80916-2332 |
Second Address | Colorado Springs, CO 80916-2332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2019 |
Last Update Date | 22/11/2021 |