Provider Demographics
NPI:1396046496
Name:CAROLYN DURHAM INC
Entity type:Organization
Organization Name:CAROLYN DURHAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RMT
Authorized Official - Phone:719-229-9238
Mailing Address - Street 1:611 N NEVADA AVE
Mailing Address - Street 2:SUITE3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1099
Mailing Address - Country:US
Mailing Address - Phone:719-229-9235
Mailing Address - Fax:719-447-9262
Practice Address - Street 1:611 N NEVADA AVE
Practice Address - Street 2:SUITE3
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1099
Practice Address - Country:US
Practice Address - Phone:719-229-9235
Practice Address - Fax:719-447-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty