Provider Demographics
NPI:1508576844
Name:GATTI, VINCENT A SR (ACA0008058 08312023)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:GATTI
Suffix:SR
Gender:M
Credentials:ACA0008058 08312023
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:A
Other - Last Name:GATTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAT ACA000805808
Mailing Address - Street 1:1004 CARBON
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3664
Mailing Address - Country:US
Mailing Address - Phone:719-846-4153
Mailing Address - Fax:
Practice Address - Street 1:1004 CARBON
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3664
Practice Address - Country:US
Practice Address - Phone:719-846-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCATCACACA0008058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)