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General NPI Number Information
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NPI Number | 1477580850
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Entity Type | Individual
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Provider Name | GARY A FENSTER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/20/2008
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Provider Practice Location Address
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Address Line | 357 MCCASLIN BLVD SUITE 200
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City | LOUISVILLE
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State | CO
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Zip | 80027-2941
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Country | US
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Telephone | 303-666-4903
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Fax | 303-926-5201
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Provider Business Mailing Address
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Address Line | 814 OWL DR
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City | LOUISVILLE
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State | CO
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Zip | 80027-2728
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Country | US
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Telephone | 303-666-4903
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Fax | 303-926-5201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1270
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License Number State | CO
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