Provider Demographics
NPI:1750857876
Name:MIDDLETON, GARLAND (LSW)
Entity Type:Individual
Prefix:
First Name:GARLAND
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3929
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-3700
Mailing Address - Country:US
Mailing Address - Phone:845-417-6517
Mailing Address - Fax:
Practice Address - Street 1:483 HAVERLY ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-9613
Practice Address - Country:US
Practice Address - Phone:845-417-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009922230101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor