Provider Demographics
NPI:1568608867
Name:STEELE, ROBERT FOSTER (MA, LISAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FOSTER
Last Name:STEELE
Suffix:
Gender:M
Credentials:MA, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E. GURLEY ST
Mailing Address - Street 2:STE D
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-778-5400
Mailing Address - Fax:928-778-5480
Practice Address - Street 1:615 E. GURLEY ST
Practice Address - Street 2:STE D
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-778-5400
Practice Address - Fax:928-778-5480
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10435101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAHCCCS115452OtherAHCCCS