Active NPI
Michael Black, LCSW, CACIII
- Addiction (Substance Use Disorder) Counselor
- Denver, CO
National Provider Identifier
1659679199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- ACC-7098
- Practice address
- 1212 S Broadway
Suite 200
Denver, CO 80210-1582 - Phone
- (303) 957-7567
- Fax
- (303) 934-1262
- NPI assigned
- Mar 8, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ACC-7098 | CO | Primary |
| Clinical Social Worker | 1041C0700X | CSW-1229 | CO |
Addresses
Primary practice location
1212 S Broadway
Suite 200
Denver, CO 80210-1582
Mailing address
1212 S Broadway
Suite 200
Denver, CO 80210-1582
Phone (303) 957-7567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACC-7098 | CO | MD | Addiction (Substance Use Disorder) Counselor |
| CSW-1229 | CO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299542400000",
"number": "1659679199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 S BROADWAY",
"address_2": "SUITE 200",
"city": "DENVER",
"state": "CO",
"postal_code": "802101582",
"telephone_number": "303-957-7567",
"fax_number": "303-934-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 S BROADWAY",
"address_2": "SUITE 200",
"city": "DENVER",
"state": "CO",
"postal_code": "802101582",
"telephone_number": "303-957-7567",
"fax_number": "303-934-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "MICHAEL",
"credential": "LCSW, CACIII",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-08",
"last_updated": "2011-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "ACC-7098",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "CSW-1229",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.