Provider Demographics
NPI:1619272689
Name:CARRIS PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:CARRIS PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-712-9797
Mailing Address - Street 1:743 HORIZON CT
Mailing Address - Street 2:SUITE 368
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8701
Mailing Address - Country:US
Mailing Address - Phone:970-712-9797
Mailing Address - Fax:970-241-9292
Practice Address - Street 1:743 HORIZON CT
Practice Address - Street 2:SUITE 368
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8701
Practice Address - Country:US
Practice Address - Phone:970-712-9797
Practice Address - Fax:970-241-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103747Medicare PIN