Healthcare Provider Details

I. General information

NPI: 1629796669
Provider Name (Legal Business Name): JENILLE A GUDAHL LPC, LAC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 HORIZON CT STE 111
GRAND JUNCTION CO
81506-8718
US

IV. Provider business mailing address

598 SHOSHONE ST
GRAND JUNCTION CO
81504-5681
US

V. Phone/Fax

Practice location:
  • Phone: 970-361-1038
  • Fax: 970-644-5147
Mailing address:
  • Phone: 970-361-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENILLE GUDAHL
Title or Position: OWNER
Credential:
Phone: 970-361-1038