Provider Demographics
NPI:1730348061
Name:LANDIN, CARRIE MICHELE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:MICHELE
Last Name:LANDIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:M
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3055 ROSLYN ST UNIT 250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3055 ROSLYN ST UNIT 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2778
Practice Address - Country:US
Practice Address - Phone:720-553-2750
Practice Address - Fax:720-553-2763
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4062Medicare PIN