Individual
MR. ANTHONY NATHAN RISKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MFTC
Contact information
Practice address
1359 AGAPE WAY, LAFAYETTE, CO 80026-1487
(810) 691-6689
Mailing address
1359 AGAPE WAY, LAFAYETTE, CO 80026-1487
(810) 691-6689
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0013863
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-2340136
IRS
CO
Enumeration date
10/21/2021
Last updated
10/21/2021
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