Individual
MR. GARY HANNEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 S PAGOSA BLVD, PAGOSA SPRINGS, CO 81147-7910
(970) 946-2540
Mailing address
PO BOX 2601, PAGOSA SPRINGS, CO 81147-2601
(970) 731-6140
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0064381
NM
101YP2500X
Professional Counselor
Primary
1631
CO
101YP2500X
Professional Counselor
2624-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064381
MENTAL HEALTH COUNSELOR
NM
01
—
1631
LPC
CO
01
—
2624-125
LPC
WI
Enumeration date
07/06/2006
Last updated
07/21/2022
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