Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6138 | CO |
NPI | 1003024381 |
---|---|
Provider Name | Mr. Darren Mitchell Speier |
First Address | Pueblo West, CO 81007-1738 |
Second Address | Pueblo, CO 81001-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |