Provider Demographics
NPI:1417574526
Name:SPRAGUE, GARY (LCSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8748
Mailing Address - Country:US
Mailing Address - Phone:719-687-0515
Mailing Address - Fax:
Practice Address - Street 1:16222 W US HIGHWAY 24 STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8763
Practice Address - Country:US
Practice Address - Phone:719-686-0878
Practice Address - Fax:719-365-7885
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099262141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical