Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ACC.0000911 | CO |
NPI | 1003222969 |
---|---|
Provider Name | Velma G Gallegos |
First Address | Fort Collins, CO 80525-3934 |
Second Address | Fort Collins, CO 80521-2612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 10/07/2014 |