Organization
CLINICAL SOCIAL WORK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR GATES-CRANDALL PHD (LCSW)
(719) 900-5279
Entity
Organization
Contact information
Practice address
3000 WEDGEWOOD DR # 2215, PUEBLO, CO 81005-2300
(719) 900-5279
Mailing address
3000 WEDGEWOOD DR # 2215, PUEBLO, CO 81005-2300
(719) 900-5279
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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