Provider Demographics
NPI:1528212966
Name:GAINER, JUDITH G (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:GAINER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:719-439-9297
Mailing Address - Fax:
Practice Address - Street 1:5040 CORPORATE PLAZA DR STE 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-6100
Practice Address - Country:US
Practice Address - Phone:719-439-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012735101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81-3065331OtherCIGNA