Provider Demographics
NPI:1629412929
Name:TOBIN, CARLY MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:MICHELLE
Last Name:TOBIN
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 1:4441 S XERIC WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2529
Mailing Address - Country:US
Mailing Address - Phone:303-918-6143
Mailing Address - Fax:
Practice Address - Street 1:4441 S XERIC WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2529
Practice Address - Country:US
Practice Address - Phone:303-918-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities