Provider Demographics
NPI:1336287846
Name:UNRUH, GARY (MSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 LONGVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8060
Mailing Address - Country:US
Mailing Address - Phone:719-481-2032
Mailing Address - Fax:
Practice Address - Street 1:7870 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3920
Practice Address - Country:US
Practice Address - Phone:719-481-8618
Practice Address - Fax:719-599-0045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8763171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical