Provider Demographics
NPI:1275899742
Name:GOWINS, RONALD A (CAS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:GOWINS
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VESTA RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9327
Mailing Address - Country:US
Mailing Address - Phone:719-972-2066
Mailing Address - Fax:
Practice Address - Street 1:111 VESTA RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9327
Practice Address - Country:US
Practice Address - Phone:719-792-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC3 - 6349101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)