1891894390 NPI number — DR. PATRICIA GUFFEY CARRUTH PSYD, MSW

Table of content: DR. PATRICIA GUFFEY CARRUTH PSYD, MSW (NPI 1891894390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891894390 NPI number — DR. PATRICIA GUFFEY CARRUTH PSYD, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRUTH
Provider First Name:
PATRICIA
Provider Middle Name:
GUFFEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891894390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3393 IRIS AVENUE, SUITE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-415-2725
Provider Business Mailing Address Fax Number:
720-302-0450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4135 AUTUMN COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-588-1788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2447 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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