Doctor Name: | JOHN T REAL |
NPI Number: | 1154372761 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | 3040 |
Business Practice Address: | 711 Grand Ave Glenwood Springs, CO - 816013401 |
Business Phone Number: | 9709458439 |
Business Fax Number: | 9709451040 |
Mailing Address: | Po Box 40, GLENWOOD SPRINGS |
State: | CO |
Postal Code: | 816020040 |
Phone Number: | 9709452241 |
Fax Number: | 9709455523 |
NPI Enumeration Date: | 05/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 3040 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |