Provider Demographics
NPI:1215003736
Name:KIEFT, GORDON JAY (MDIV, MA)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:JAY
Last Name:KIEFT
Suffix:
Gender:M
Credentials:MDIV, MA
Other - Prefix:MR
Other - First Name:GORDON
Other - Middle Name:JAY
Other - Last Name:KIEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MDIV, MA
Mailing Address - Street 1:9185 E KENYON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1822
Mailing Address - Country:US
Mailing Address - Phone:303-741-5588
Mailing Address - Fax:303-756-7703
Practice Address - Street 1:6500 E GIRARD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2849
Practice Address - Country:US
Practice Address - Phone:303-741-5588
Practice Address - Fax:303-756-7703
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health