Provider Demographics
NPI:1053844001
Name:GESTALT PSYCHOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:GESTALT PSYCHOTHERAPY ASSOCIATES
Other - Org Name:MARCIA CROSS LCSW D/B/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-916-8501
Mailing Address - Street 1:6565 W JEWELL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7187
Mailing Address - Country:US
Mailing Address - Phone:303-916-8501
Mailing Address - Fax:
Practice Address - Street 1:6565 W JEWELL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7187
Practice Address - Country:US
Practice Address - Phone:303-916-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO989713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO989713OtherMINES AND ASSOCIATES