Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 3204 | CO |
NPI | 1003092727 |
---|---|
Provider Name | Robert B. Wenzel |
First Address | Colorado Springs, CO 80918-7224 |
Second Address | Colorado Springs, CO 80918-7224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2008 |
Last Update Date | 04/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12018498 | CAQH (01) | CO |
532691 | (05) | CO |