Basic Information
| Provider Information | |||||||||
| NPI: | 1730302605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FROUG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 CHAMBERS RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172753 | ||||||||
| FaxNumber: | 3036172562 | ||||||||
| Practice Location | |||||||||
| Address1: | 1290 CHAMBERS RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800117117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172753 | ||||||||
| FaxNumber: | 3036172562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 04025094 | 05 | CO | MEDICAID |