Healthcare Provider Details

I. General information

NPI: 1194752436
Provider Name (Legal Business Name): GARY TOUB, PH.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 LAFAYETTE ST
DENVER CO
80218-2315
US

IV. Provider business mailing address

1271 LAFAYETTE ST
DENVER CO
80218-2315
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-2448
  • Fax: 303-394-4933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number635
License Number StateCO

VIII. Authorized Official

Name: DR. GARY S. TOUB
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 303-278-2448