Provider Demographics
NPI:1821008475
Name:SIMS, GREGORY L (LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:SIMS
Suffix:
Gender:M
Credentials:LPC
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 7379
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0379
Mailing Address - Country:US
Mailing Address - Phone:719-647-9930
Mailing Address - Fax:719-297-4619
Practice Address - Street 1:19 E ABARR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-5436
Practice Address - Country:US
Practice Address - Phone:719-647-9930
Practice Address - Fax:719-297-4619
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10805851Medicaid