Provider Demographics
NPI:1447093653
Name:UNRUH, MYRON (LPC)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 TOLTEC LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4226
Mailing Address - Country:US
Mailing Address - Phone:719-217-5245
Mailing Address - Fax:
Practice Address - Street 1:2020 N ACADEMY BLVD STE 252
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1568
Practice Address - Country:US
Practice Address - Phone:719-217-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional