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General NPI Number Information
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NPI Number | 1770898892
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Entity Type | Organization
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Legal Business Name | MARK W GIDNEY, PSYD, PC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 101 W MAIN ST SUITE 302
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City | FRISCO
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State | CO
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Zip | 80443
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Country | US
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Telephone | 970-390-7522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2214
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City | FRISCO
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State | CO
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Zip | 80443-2214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK W GIDNEY
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Credential |
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Telephone | 970-390-7522
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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 | 2120
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License Number State | CO
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