Provider Demographics
NPI:1578306700
Name:HERLYN, GABRIELLE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:HERLYN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:PSY
Other - Middle Name:
Other - Last Name:HERLYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12122 COLORADO BLVD APT F308
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-4231
Mailing Address - Country:US
Mailing Address - Phone:605-413-3235
Mailing Address - Fax:
Practice Address - Street 1:12122 COLORADO BLVD APT F308
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-4231
Practice Address - Country:US
Practice Address - Phone:605-413-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician