Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 1308 | CO |
Y | 101YM0800X | Mental Health Counselor | 977022 | CO |
NPI | 1003131301 |
---|---|
Provider Name | Mr. Leonard Dale Mcpherson |
First Address | Boulder, CO 80303-2317 |
Second Address | Boulder, CO 80303-2317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 30/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1308 | B.C.D. (01) | CO |
977022 | L.C.S.W. II (01) | CO |