Healthcare Provider Details

I. General information

NPI: 1013300243
Provider Name (Legal Business Name): DR. JESSICA GELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N LOGAN ST STE 101
DENVER CO
80203-3009
US

IV. Provider business mailing address

1600 GLENARM PL APT 1002
DENVER CO
80202-4315
US

V. Phone/Fax

Practice location:
  • Phone: 303-476-8165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY.0004716
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: