Provider Demographics
NPI:1093908139
Name:KEHL, MICHEAL (ACSW LCSW MSW)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:
Last Name:KEHL
Suffix:
Gender:M
Credentials:ACSW LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-493-3833
Mailing Address - Fax:970-493-4333
Practice Address - Street 1:1037 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-493-3833
Practice Address - Fax:970-493-4333
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9820371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical