Provider Demographics
NPI:1629227590
Name:BAIR, STEPHEN RAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RAY
Last Name:BAIR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2744
Mailing Address - Country:US
Mailing Address - Phone:970-641-1694
Mailing Address - Fax:
Practice Address - Street 1:104 EMERALD LN
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2744
Practice Address - Country:US
Practice Address - Phone:970-641-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9915101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical