Individual provider Active NPI

Gary A Fenster, PH.D.

  • Psychologist
  • Louisville, CO
National Provider Identifier
1477580850
Registry record updated Jul 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1270 Issued in CO
Practice address
357 McCaslin Blvd
Suite 200
Louisville, CO 80027-2941
Phone
(303) 666-4903
Fax
(303) 926-5201
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1270 CO Primary

Addresses

Primary practice location

357 McCaslin Blvd
Suite 200
Louisville, CO 80027-2941

Mailing address

814 Owl Dr
Louisville, CO 80027-2728
Phone (303) 666-4903

Other identifiers 1

IdentifierTypeStateIssuer
07012701MedicaidCO

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1270COMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216512000000",
    "number": "1477580850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 OWL DR",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272728",
            "telephone_number": "303-666-4903",
            "fax_number": "303-926-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 MCCASLIN BLVD",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272941",
            "telephone_number": "303-666-4903",
            "fax_number": "303-926-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSTER",
        "first_name": "GARY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "1270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07012701",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.