=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043380405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANIE HELEN ROTHENMAIER L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 02/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 10TH ST STE 104
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-562-4906
-----------------------------------------------------
Fax | 303-384-3220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3154 SULKY LN
-----------------------------------------------------
City | EVERGREEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80439-8623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-674-7127
-----------------------------------------------------
Fax | 303-384-3220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 821
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------