MEDICARE: MR. GARY ALLEN EMERY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4855	CO

General Provider Information

NPI Number	:	1023317120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY ALLEN EMERY LPC

Provider Business Mailing Address
First Line	:	803 E MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3105
Country	:	US
Telephone Number	:	970-490-1309
Fax Number	:	970-490-8940

Provider Business Practice Location Address
First Line	:	803 E MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3105
Country	:	US
Telephone Number	:	970-490-1309
Fax Number	:	970-490-8940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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