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Individual

MICHAEL COSTELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.S., LAC

Contact information

Practice address
114 N 12TH ST, GRAND JUNCTION, CO 81501-3534
(970) 549-9050
Mailing address
377 RODELL DR, GRAND JUNCTION, CO 81507-1744

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ACD.0000462
CO

Other

Enumeration date
10/14/2017
Last updated
10/14/2017
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