Healthcare Provider Details

I. General information

NPI: 1114278892
Provider Name (Legal Business Name): JENNA DEUBLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 DONELAN AVE
BURLINGTON CO
80807-1401
US

IV. Provider business mailing address

1209 E 4TH AVE
LONGMONT CO
80504-1335
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-2040
  • Fax:
Mailing address:
  • Phone: 719-203-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0018418
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: