Provider Demographics
NPI:1053530949
Name:GRETHER, TIM A (LCSW)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:A
Last Name:GRETHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S SAINT VRAIN AVE UNIT G4
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7471
Mailing Address - Country:US
Mailing Address - Phone:970-577-9322
Mailing Address - Fax:970-586-9024
Practice Address - Street 1:517 BIG THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9661
Practice Address - Country:US
Practice Address - Phone:970-586-8077
Practice Address - Fax:970-586-9024
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9912191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical