Healthcare Provider Details

I. General information

NPI: 1437456746
Provider Name (Legal Business Name): LYDIA CAMIELL GAREY PN-25642, ACC-6941
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GAYLORD ST
DENVER CO
80206-1207
US

IV. Provider business mailing address

14005 E 54TH AVE
DENVER CO
80239-4109
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-5894
  • Fax: 303-336-1601
Mailing address:
  • Phone: 303-204-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC-6941
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN-25642
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: