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BOBBY LEE GANT PHD

Clinical Neuropsychologist

Boulder, Colorado

Provider NPI: 1326104415

Provider Information:
 BOBBY LEE GANT PHD
Gender: M
Not Sole Proprietor

Practice Location:
255 CANYON BLVD STE 300F  BOULDER, CO 80302 US
Tel: 972-570-8200  Fax: 972-402-5621

Business Mailing Address:
5455 LEE HILL DR  BOULDER, CO 80302 US
Tel: 720-552-2995  Fax: 972-402-5621

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
COPSY.0002998
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
TX21788
N103TC2200XBehavioral Health & Social Service Providers
Psychologist
CO2998
N103TR0400XBehavioral Health & Social Service Providers
Psychologist
CO2998
N209800000XPhysicians
Legal Medicine
CO2998
N2084S0012XPhysicians
Psychiatry & Neurology
CO2998
N103TH0004XBehavioral Health & Social Service Providers
Psychologist
CO2998

Other Provider Identifiers:

IssuerNumberStateType
STATE LICENSE2998CO01
9000168090CO05
STATE LICENSE21788TX01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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