Provider Demographics
NPI:1851477327
Name:GEGICH, DARLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:DARLEEN
Middle Name:
Last Name:GEGICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 BROADWAY ST.
Mailing Address - Street 2:307
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:720-515-4711
Mailing Address - Fax:
Practice Address - Street 1:1910 7TH STREE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302
Practice Address - Country:US
Practice Address - Phone:720-515-4711
Practice Address - Fax:720-583-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18742101YP2500X
CO6102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional