Provider Demographics
NPI:1558568436
Name:COATS, GARY LEE (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:COATS
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 1:9543 W CALEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3103
Mailing Address - Country:US
Mailing Address - Phone:303-756-5400
Mailing Address - Fax:303-972-6463
Practice Address - Street 1:8340 SANGRE DE CRISTO RD
Practice Address - Street 2:STE 207
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4248
Practice Address - Country:US
Practice Address - Phone:303-756-5400
Practice Address - Fax:303-972-6463
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1657103TC0700X
SD454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014809Medicaid
COR 19505Medicare UPIN
COCA 3106Medicare ID - Type UnspecifiedMEDICARE