Provider Demographics
NPI:1649559634
Name:MARTINEZ-AUGELLO, GLADYS M (MSW,LAC, ACD)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:M
Last Name:MARTINEZ-AUGELLO
Suffix:
Gender:F
Credentials:MSW,LAC, ACD
Other - Prefix:MS
Other - First Name:GLADYS
Other - Middle Name:M
Other - Last Name:MARTINEZ-DELISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CACII
Mailing Address - Street 1:715 HORIZON DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 CASTLE CREEK RD STE 207
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-920-5555
Practice Address - Fax:970-920-5557
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6921101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health