Healthcare Provider Details

I. General information

NPI: 1215003736
Provider Name (Legal Business Name): GORDON JAY KIEFT M.DIV., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GORDON JAY KIEFT M.DIV., M.A.

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 E GIRARD AVE
DENVER CO
80224-2849
US

IV. Provider business mailing address

9185 E KENYON AVE SUITE 120
DENVER CO
80237-1822
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-5588
  • Fax: 303-756-7703
Mailing address:
  • Phone: 303-741-5588
  • Fax: 303-756-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 430
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: