Provider Demographics
NPI:1336546241
Name:WALTERS, CARLY (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1028
Mailing Address - Country:US
Mailing Address - Phone:303-399-4890
Mailing Address - Fax:303-399-9846
Practice Address - Street 1:1501 ALBION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1028
Practice Address - Country:US
Practice Address - Phone:303-399-4890
Practice Address - Fax:303-399-9846
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5051103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent