Provider Demographics
NPI:1013138320
Name:WEST, GARY DWAYNE (MSW, LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DWAYNE
Last Name:WEST
Suffix:
Gender:M
Credentials:MSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 BROADMOOR VALLEY RD
Mailing Address - Street 2:STE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4406
Mailing Address - Country:US
Mailing Address - Phone:719-576-6617
Mailing Address - Fax:719-579-9792
Practice Address - Street 1:2965 BROADMOOR VALLEY RD
Practice Address - Street 2:STE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4406
Practice Address - Country:US
Practice Address - Phone:719-576-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8763301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical