Provider Demographics
NPI:1134930233
Name:HARRILL, GAVIN (MA, MFTC)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:HARRILL
Suffix:
Gender:M
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6293 W JEWELL AVE UNIT 223
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7120
Mailing Address - Country:US
Mailing Address - Phone:720-979-7513
Mailing Address - Fax:
Practice Address - Street 1:6273 W JEWELL AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7113
Practice Address - Country:US
Practice Address - Phone:720-593-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist