Healthcare Provider Details

I. General information

NPI: 1962349571
Provider Name (Legal Business Name): ANTHONY GAUTHIER MS, LPCC, ADDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N CASCADE AVE STE 1
COLORADO SPGS CO
80903-3234
US

IV. Provider business mailing address

611 N CASCADE AVE STE 1
COLORADO SPGS CO
80903-3234
US

V. Phone/Fax

Practice location:
  • Phone: 719-649-9017
  • Fax:
Mailing address:
  • Phone: 719-649-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number.0021575
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number.0000394
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: