Active NPI
Gary Hannemann
- Professional Counselor
- Pagosa Springs, CO
National Provider Identifier
1063443091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1631
- Practice address
- 75 S Pagosa Blvd
Pagosa Springs, CO 81147-7910 - Phone
- (970) 946-2540
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1631 | CO | Primary |
| Professional Counselor | 101YP2500X | 2624-125 | WI | |
| Professional Counselor | 101YP2500X | 0064381 | NM |
Addresses
Primary practice location
75 S Pagosa Blvd
Pagosa Springs, CO 81147-7910
Mailing address
PO Box 2601
Pagosa Springs, CO 81147-2601
Phone (970) 731-6140
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0064381 | Other | NM | MENTAL HEALTH COUNSELOR |
| 1631 | Other | CO | LPC |
| 2624-125 | Other | WI | LPC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0064381 | NM | MD | Professional Counselor |
| 2624-125 | WI | MD | Professional Counselor |
| 1631 | CO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1063443091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2601",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "811472601",
"telephone_number": "970-731-6140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 S PAGOSA BLVD",
"city": "PAGOSA SPRINGS",
"state": "CO",
"postal_code": "811477910",
"telephone_number": "970-946-2540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNEMANN",
"first_name": "GARY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CO",
"license": "1631",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "2624-125",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "0064381",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTAL HEALTH COUNSELOR",
"identifier": "0064381",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPC",
"identifier": "1631",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPC",
"identifier": "2624-125",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pagosa Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.