Provider Demographics
NPI:1528232253
Name:CARNAHAN, GWEN
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8341 SANGRE DE CRISTO RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4244
Mailing Address - Country:US
Mailing Address - Phone:303-225-5852
Mailing Address - Fax:
Practice Address - Street 1:8341 SANGRE DE CRISTO RD STE 206
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4244
Practice Address - Country:US
Practice Address - Phone:303-225-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
COMFT.0001169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist