Provider Demographics
NPI:1720825912
Name:WARDELL, ROBERT ERIK (LPCC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ERIK
Last Name:WARDELL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623
Mailing Address - Country:US
Mailing Address - Phone:970-300-8707
Mailing Address - Fax:
Practice Address - Street 1:1941 DOLORES WAY
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2235
Practice Address - Country:US
Practice Address - Phone:970-300-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health