Provider Demographics
NPI:1285751875
Name:AMY GORSLINE, PSYD, PLLC
Entity type:Organization
Organization Name:AMY GORSLINE, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-831-0505
Mailing Address - Street 1:673 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3506
Mailing Address - Country:US
Mailing Address - Phone:303-831-0505
Mailing Address - Fax:303-860-0970
Practice Address - Street 1:673 GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3506
Practice Address - Country:US
Practice Address - Phone:303-831-0505
Practice Address - Fax:303-860-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803149Medicare ID - Type Unspecified