Healthcare Provider Details

I. General information

NPI: 1437680824
Provider Name (Legal Business Name): ZACHARY GAITER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 E. QUINCY AVE
WATKINS CO
80137
US

IV. Provider business mailing address

4783 S YAMPA ST
AURORA CO
80015-3257
US

V. Phone/Fax

Practice location:
  • Phone: 303-766-3000
  • Fax:
Mailing address:
  • Phone: 402-913-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: