Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2120 | CO |
Y | 103TC0700X | Clinical Psychologist | 2120 | CO |
N | 103TC1900X | Counseling Psychologist | 2120 | CO |
NPI | 1083711097 |
---|---|
Provider Name | Mark W Gidney |
First Address | Frisco, CO 80443 |
Second Address | Frisco, CO 80443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 01/11/2019 |