MEDICARE: CHARLES HARRY WINGFIELD LCSW CACIII

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	2049	CO
2	104100000X	Social Worker	991320	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174540009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HARRY WINGFIELD LCSW CACIII

Provider Business Mailing Address
First Line	:	44 E SPAULDING AVE
Second Line	:	STE 4
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-251-0398
Fax Number	:	719-547-4056

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE
Second Line	:	STE 4
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-564-9039
Fax Number	:	719-561-8752

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/17/2016

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