Provider Demographics
NPI:1932236213
Name:BLEAU, WILLIAM R (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BLEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 W JEWELL AVE
Mailing Address - Street 2:SUITE 251
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4139
Mailing Address - Country:US
Mailing Address - Phone:303-989-2129
Mailing Address - Fax:303-989-1362
Practice Address - Street 1:13701 W JEWELL AVE
Practice Address - Street 2:SUITE 251
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4139
Practice Address - Country:US
Practice Address - Phone:303-989-2129
Practice Address - Fax:303-989-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4183101YM0800X
FLLB00074B101YP1600X
ILCERTIFICATE 00038259225C00000X
CO6311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)