Provider Demographics
NPI:1790937449
Name:GORRELL, CARLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:GORRELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7754 MALAMUTE TRL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6235
Mailing Address - Country:US
Mailing Address - Phone:303-548-9406
Mailing Address - Fax:303-674-0923
Practice Address - Street 1:9767 RHODUS ST
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433
Practice Address - Country:US
Practice Address - Phone:303-548-9406
Practice Address - Fax:303-674-0923
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical