| Jenille A Gudahl Lpc, Lac, Llc | |
|
800 Belford Ave Ste 200a Grand Jct CO 81501-3100 | |
| (970) 361-1038 | |
| Not Available |
| Full Name | Jenille A Gudahl Lpc, Lac, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 800 Belford Ave Ste 200a, Grand Jct, Colorado |
| Authorized Official Name and Position | Jenille Gudahl (OWNER) |
| Authorized Official Contact | 9703611038 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jenille A Gudahl Lpc, Lac, Llc 598 Shoshone St Grand Junction CO 81504-5681 Ph: (970) 361-1038 | Jenille A Gudahl Lpc, Lac, Llc 800 Belford Ave Ste 200a Grand Jct CO 81501-3100 Ph: (970) 361-1038 |
| NPI Number | 1629796669 |
|---|---|
| Provider Enumeration Date | 08/16/2022 |
| Last Update Date | 05/18/2023 |
| Certification Date | 05/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629796669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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