Provider Demographics
NPI:1285259002
Name:THREATT, GERRY (LMHC LH 61288295)
Entity type:Individual
Prefix:MR
First Name:GERRY
Middle Name:
Last Name:THREATT
Suffix:
Gender:M
Credentials:LMHC LH 61288295
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81240-9643
Mailing Address - Country:US
Mailing Address - Phone:785-375-2608
Mailing Address - Fax:
Practice Address - Street 1:15 GRANT ST
Practice Address - Street 2:
Practice Address - City:PENROSE
Practice Address - State:CO
Practice Address - Zip Code:81240-9643
Practice Address - Country:US
Practice Address - Phone:785-375-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61288295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty