MEDICARE: TIM A GRETHER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	991219	CO

General Provider Information

NPI Number	:	1053530949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM A GRETHER LCSW

Provider Business Mailing Address
First Line	:	1010 S SAINT VRAIN AVE UNIT G4
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-7471
Country	:	US
Telephone Number	:	970-577-9322
Fax Number	:	970-586-9024

Provider Business Practice Location Address
First Line	:	517 BIG THOMPSON AVE
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-9661
Country	:	US
Telephone Number	:	970-586-8077
Fax Number	:	970-586-9024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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Directions to “ TIM A GRETHER LCSW” Practice Location

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