Provider Demographics
NPI:1962975813
Name:HILLSTROM, MICHAEL ELDEN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ELDEN
Last Name:HILLSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 COLONY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2235
Mailing Address - Country:US
Mailing Address - Phone:719-209-3959
Mailing Address - Fax:
Practice Address - Street 1:112 IOWA AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5947
Practice Address - Country:US
Practice Address - Phone:719-358-7338
Practice Address - Fax:844-273-2340
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008413101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)