Individual
JUSTIN M GAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4776 EAGLERIDGE CIR, PUEBLO, CO 81008-2189
(719) 584-5183
(719) 584-5496
Mailing address
4776 EAGLERIDGE CIR, PUEBLO, CO 81008-2189
(719) 584-5183
(719) 584-5496
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4401
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4401
LCSW LICENSURE
HI
Enumeration date
02/19/2019
Last updated
02/19/2019
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