Provider Demographics
NPI:1881672913
Name:JOHANSSON, CARRIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:JOHANSSON
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 1:2855 N SPEER BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4239
Mailing Address - Country:US
Mailing Address - Phone:303-355-6682
Mailing Address - Fax:303-237-4128
Practice Address - Street 1:2855 N SPEER BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4239
Practice Address - Country:US
Practice Address - Phone:303-355-6682
Practice Address - Fax:303-237-4128
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CO2710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist