Provider Demographics
NPI:1902956113
Name:GARY L COATS PHD PA
Entity Type:Organization
Organization Name:GARY L COATS PHD PA
Other - Org Name:ASPEN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-756-5400
Mailing Address - Street 1:9543 W CALEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123
Mailing Address - Country:US
Mailing Address - Phone:303-756-5400
Mailing Address - Fax:303-972-6463
Practice Address - Street 1:8361 S SANGRE DE CRISTO ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:303-756-5400
Practice Address - Fax:303-972-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014809Medicaid
COR19505Medicare UPIN
COCA3106Medicare ID - Type Unspecified