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NPI Code Detail

MEDICARE: HENRY GARRETT MAXWELL CAC II

MEDICARE: HENRY GARRETT MAXWELL CAC II
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACB.0008228CO

General Provider Information

NPI Number : 1750883161
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY GARRETT MAXWELL CAC II
Provider Business Mailing Address
First Line : 5351 COUNTY ROAD 100
Second Line :
City : CARBONDALE
State : CO
Zip : 81623-8812
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 811 MAIN CT
Second Line :
City : CARBONDALE
State : CO
Zip : 81623-1851
Country : US
Telephone Number : 970-704-9292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2018
Last Update Date : 03/01/2018

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