Provider Demographics
NPI:1780139667
Name:NUSS, GALVIN
Entity type:Individual
Prefix:
First Name:GALVIN
Middle Name:
Last Name:NUSS
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 1:239 ASPEN CIR
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-8608
Mailing Address - Country:US
Mailing Address - Phone:719-492-9346
Mailing Address - Fax:
Practice Address - Street 1:239 ASPEN CIR
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-8608
Practice Address - Country:US
Practice Address - Phone:719-492-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst