Active NPI
Gary Thomas Wareham, LPC
- Mental Health Counselor
- Thornton, CO
National Provider Identifier
1265764591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3951
- Practice address
- 8801 Lipan St
Thornton, CO 80260-4912 - Phone
- (303) 412-3625
- Fax
- (303) 657-3727
- NPI assigned
- Feb 11, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3951 | CO | |
| Mental Health Counselor | 101YM0800X | 3951 | CO | Primary |
Addresses
Primary practice location
8801 Lipan St
Thornton, CO 80260-4912
Mailing address
8801 Lipan St
Thornton, CO 80260-4912
Phone (303) 412-3625
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 840705495 | Medicaid | CO |
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 |
|---|---|---|---|
| 3951 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265846400000",
"number": "1265764591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8801 LIPAN ST",
"city": "THORNTON",
"state": "CO",
"postal_code": "802604912",
"telephone_number": "303-412-3625",
"fax_number": "303-657-3727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8801 LIPAN ST",
"city": "THORNTON",
"state": "CO",
"postal_code": "802604912",
"telephone_number": "303-412-3625",
"fax_number": "303-657-3727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAREHAM",
"first_name": "GARY",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-11",
"last_updated": "2010-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "3951",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "3951",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "840705495",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thornton, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.