Provider Demographics
NPI:1104902519
Name:EARLL, STEVEN L (MA, MS, LFC, LAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:EARLL
Suffix:
Gender:M
Credentials:MA, MS, LFC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4291 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2903
Mailing Address - Country:US
Mailing Address - Phone:719-528-1929
Mailing Address - Fax:719-532-0897
Practice Address - Street 1:4291 AUSTIN BLUFFS PKWY
Practice Address - Street 2:STE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2903
Practice Address - Country:US
Practice Address - Phone:719-528-1929
Practice Address - Fax:719-532-0897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2544103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist