Provider Demographics
NPI:1841389749
Name:GAYLOR, CAROLYN LOUISE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:GAYLOR
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 1:525 S 57TH PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5410
Mailing Address - Country:US
Mailing Address - Phone:541-744-0394
Mailing Address - Fax:
Practice Address - Street 1:525 S 57TH PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5410
Practice Address - Country:US
Practice Address - Phone:541-744-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator