Provider Demographics
NPI:1972848380
Name:BANUELOS, RICARDO (MA, CAC III)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:BANUELOS
Suffix:
Gender:M
Credentials:MA, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 ZUNI ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4778
Mailing Address - Country:US
Mailing Address - Phone:303-823-1988
Mailing Address - Fax:
Practice Address - Street 1:8380 ZUNI ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4778
Practice Address - Country:US
Practice Address - Phone:303-823-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-6256101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)