Henry Garrett Maxwell, CAC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

ACB.0008228 Issued in CO

Practice address

811 Main CT
Carbondale, CO 81623-1851

Phone

(970) 704-9292

NPI assigned

Mar 1, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jaywalker Lodge Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Carbondale, CO
  • NPI 1972901080
  NPD (past)
• Jaywalker Lodge, LLC

  • Substance Abuse Rehabilitation Facility
  • Carbondale, CO
  • NPI 1750657482
  NPD (past)

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1750883161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5351 COUNTY ROAD 100",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "816238812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 MAIN CT",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "816231851",
            "telephone_number": "970-704-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "HENRY",
        "middle_name": "GARRETT",
        "credential": "CAC II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CO",
            "license": "ACB.0008228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Manchester
• David Mitchell Marcus, M.D.
• Mark a Cook DDS PC
• Mark a Cook DDS PC
• Julie A Martin, MA, LPC
• Bridget Calland McClain, PHARMD
• Jordon McIlvain
• James Todd Means, OTR
• Mending Mountains Therapy PC
• Cynthia J Metzger, OTR

• Addiction (Substance Use Disorder) Counselor in Carbondale, CO
• Providers in Carbondale, CO by specialty
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; 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.