=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710990254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA GOMEZ-WEAKLEY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 S ELATI ST SUITE 301
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-4483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-916-8847
-----------------------------------------------------
Fax | 720-283-4101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8169 S CORONA WAY
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-916-8847
-----------------------------------------------------
Fax | 720-283-4101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1883
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------