Provider Demographics
NPI:1477580850
Name:FENSTER, GARY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:FENSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 OWL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2728
Mailing Address - Country:US
Mailing Address - Phone:303-666-4903
Mailing Address - Fax:303-926-5201
Practice Address - Street 1:357 MCCASLIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2941
Practice Address - Country:US
Practice Address - Phone:303-666-4903
Practice Address - Fax:303-926-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07012701Medicaid
COR20162Medicare UPIN
COC81356Medicare PIN