Provider Demographics
NPI:1295418085
Name:GAYLORD, JOSHUA JEREMIAH
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JEREMIAH
Last Name:GAYLORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E DRAKE RD APT K55
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1870
Mailing Address - Country:US
Mailing Address - Phone:360-477-1995
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD BLDG 4201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3198
Practice Address - Country:US
Practice Address - Phone:360-477-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health