Provider Demographics
NPI:1568093540
Name:KUPFERER, GWYNETH BRONWYN (N/A)
Entity Type:Individual
Prefix:MISS
First Name:GWYNETH
Middle Name:BRONWYN
Last Name:KUPFERER
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 8TH AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5661
Mailing Address - Country:US
Mailing Address - Phone:719-437-9638
Mailing Address - Fax:
Practice Address - Street 1:710 11TH AVE STE L46
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3171
Practice Address - Country:US
Practice Address - Phone:970-888-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health