Provider Demographics
NPI:1659940930
Name:IBAVE, GARY ARTHUR (LCSW,MSW)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ARTHUR
Last Name:IBAVE
Suffix:
Gender:M
Credentials:LCSW,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 POPPY ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5544
Mailing Address - Country:US
Mailing Address - Phone:903-372-8342
Mailing Address - Fax:
Practice Address - Street 1:12482 W NEVADA PL APT 212
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3255
Practice Address - Country:US
Practice Address - Phone:903-372-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099247081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09924708OtherSTATE