Provider Demographics
NPI:1376685172
Name:FORNIA, GWEN L (LPC)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:L
Last Name:FORNIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 E ARAPAHOE RD
Mailing Address - Street 2:SUITE# 396
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1275
Mailing Address - Country:US
Mailing Address - Phone:303-770-6903
Mailing Address - Fax:303-770-6904
Practice Address - Street 1:7500 E ARAPAHOE RD
Practice Address - Street 2:SUITE# 396
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1275
Practice Address - Country:US
Practice Address - Phone:303-770-6903
Practice Address - Fax:303-770-6904
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional