Provider Demographics
NPI:1679903876
Name:COLE, GARRY LEE III (PSYD, ABPP)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:LEE
Last Name:COLE
Suffix:III
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1805 S BELLAIRE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4317
Mailing Address - Country:US
Mailing Address - Phone:304-840-7710
Mailing Address - Fax:
Practice Address - Street 1:1805 S BELLAIRE ST STE 350
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4317
Practice Address - Country:US
Practice Address - Phone:304-840-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty