Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2679 | CO |
N | 103T00000X | Psychologist | 2679 | CO |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2679 | CO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2679 | CO |
N | 103G00000X | Clinical Psychologist | 2679 | CO |
N | 103TC0700X | Clinical Psychologist | 2679 | CO |
N | 103TF0200X | Forensic Psychologist | 2679 | CO |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2679 | CO |
N | 103TP2701X | Group Psychotherapist | 2679 | CO |
N | 103TS0200X | School Psychologist | 2679 | CO |
NPI | 1326190083 |
---|---|
Provider Name | Dr. David Gage Mirich |
First Address | Wheat Ridge, CO 80214-8520 |
Second Address | Wheat Ridge, CO 80214-8520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |