Provider Demographics
NPI:1093034639
Name:GILMOUR, BRYCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:
Last Name:GILMOUR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 S PARKER RD STE 430
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2802
Mailing Address - Country:US
Mailing Address - Phone:720-263-0147
Mailing Address - Fax:
Practice Address - Street 1:2851 S PARKER RD STE 430
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2802
Practice Address - Country:US
Practice Address - Phone:720-263-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000009961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13653317OtherCAQH