Provider Demographics
NPI:1649399817
Name:GEORGE A GARRY
Entity Type:Organization
Organization Name:GEORGE A GARRY
Other - Org Name:GEORGE GARRY LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GARRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-444-5280
Mailing Address - Street 1:5884 N ORCHARD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5834
Mailing Address - Country:US
Mailing Address - Phone:303-444-5280
Mailing Address - Fax:
Practice Address - Street 1:5884 N ORCHARD CREEK CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5834
Practice Address - Country:US
Practice Address - Phone:303-444-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2016-07-25
Deactivation Date:2008-06-04
Deactivation Code:
Reactivation Date:2008-09-16
Provider Licenses
StateLicense IDTaxonomies
CO117251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health