Organization
GARY W.GOSSAGE, LICENSED CLINICAL SOCIAL WORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE G GOSSAGE (OFFICE MANAGER)
(701) 400-2592
Entity
Organization
Contact information
Practice address
1910 PAYTON CIR, COLORADO SPGS, CO 80915-1327
(701) 400-2592
Mailing address
1910 PAYTON CIR, COLORADO SPGS, CO 80915-1327
(701) 400-2592
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37220241
—
CO
Enumeration date
07/30/2019
Last updated
07/30/2019
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