Provider Demographics
NPI:1104069434
Name:GARY D WEST. MSW, PC
Entity type:Organization
Organization Name:GARY D WEST. MSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-576-6617
Mailing Address - Street 1:2985 BROADMOOR VALLEY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4484
Mailing Address - Country:US
Mailing Address - Phone:719-576-6617
Mailing Address - Fax:719-597-9792
Practice Address - Street 1:2985 BROADMOOR VALLEY RD STE 9
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4484
Practice Address - Country:US
Practice Address - Phone:719-576-6617
Practice Address - Fax:719-597-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8763301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty