Provider Demographics
NPI:1902914344
Name:GORNELL, RAYMOND E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:GORNELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 S COLORADO BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5945
Mailing Address - Country:US
Mailing Address - Phone:970-518-8809
Mailing Address - Fax:303-691-0763
Practice Address - Street 1:1815 65TH AVE
Practice Address - Street 2:#2
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7964
Practice Address - Country:US
Practice Address - Phone:970-518-8809
Practice Address - Fax:303-691-0763
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE637103TC0700X
CO2621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
279873Medicare ID - Type Unspecified