Provider Demographics
NPI:1053582825
Name:AUSBUN, GARY (LPC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:AUSBUN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:AUSBUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2812 E BIJOU ST
Mailing Address - Street 2:2812 E. BIJOU ST
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6371
Mailing Address - Country:US
Mailing Address - Phone:719-457-0660
Mailing Address - Fax:719-623-1695
Practice Address - Street 1:2812 E BIJOU ST
Practice Address - Street 2:NONE
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6371
Practice Address - Country:US
Practice Address - Phone:719-457-0660
Practice Address - Fax:719-623-1695
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 1952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health