Provider Demographics
NPI:1891180931
Name:GARY MCCUNE
Entity Type:Organization
Organization Name:GARY MCCUNE
Other - Org Name:ARAPAHOE AMEND
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-220-1911
Mailing Address - Street 1:6565 S DAYTON ST
Mailing Address - Street 2:1500
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6127
Mailing Address - Country:US
Mailing Address - Phone:303-220-1911
Mailing Address - Fax:
Practice Address - Street 1:6565 S DAYTON ST
Practice Address - Street 2:1500
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6127
Practice Address - Country:US
Practice Address - Phone:303-220-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO127OtherLICENSE NUMBER