Healthcare Provider Details

I. General information

NPI: 1235675240
Provider Name (Legal Business Name): JONELLE GOODE-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W 26TH AVE STE 217
DENVER CO
80211-5308
US

IV. Provider business mailing address

2460 W 26TH AVE STE 217
DENVER CO
80211-5308
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-7108
  • Fax: 844-800-3901
Mailing address:
  • Phone: 303-322-7108
  • Fax: 844-800-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: