Individual
SCOTT GALE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3500 BALTIMORE AVE, PUEBLO, CO 81008-1543
(719) 545-1181
(719) 545-1191
Mailing address
3500 BALTIMORE AVE, PUEBLO, CO 81008-1543
(719) 545-1181
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC.0004528
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACC.0004528
CERTIFIED ADDICTIONS SPECIALIST
CO
Enumeration date
11/30/2022
Last updated
11/30/2022
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