Basic Information
| Provider Information | |||||||||
| NPI: | 1992871743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAINBROOK | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4161 E 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802201008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033226572 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2465 S DOWNING ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037785774 | ||||||||
| FaxNumber: | 3037782436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| 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 | 101YP2500X | 2245 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 2245 | 01 | CO | LPC LICENSE | OTHER |