Healthcare Provider Details

I. General information

NPI: 1356961072
Provider Name (Legal Business Name): PAULA R CANNON GABLE LMFT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HORSETOOTH RD STE 200
FORT COLLINS CO
80525-3154
US

IV. Provider business mailing address

3027 KNOLLS END DR UNIT 5
FORT COLLINS CO
80526-5827
US

V. Phone/Fax

Practice location:
  • Phone: 303-357-9743
  • Fax: 303-985-7882
Mailing address:
  • Phone: 303-357-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001960
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: