Individual
MR. GARY THOMAS WAREHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
8801 LIPAN ST, THORNTON, CO 80260-4912
(303) 412-3625
(303) 657-3727
Mailing address
8801 LIPAN ST, THORNTON, CO 80260-4912
(303) 412-3625
(303) 657-3727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3951
CO
101YM0800X
Mental Health Counselor
Primary
3951
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
840705495
—
CO
Enumeration date
02/11/2010
Last updated
02/11/2010
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