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General NPI Number Information
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NPI Number | 1467704205
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Entity Type | Individual
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Provider Name | JEANETTE KM GRUENHAGEN LPC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 720 KIPLING ST STE 113
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City | LAKEWOOD
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State | CO
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Zip | 80215-5866
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Country | US
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Telephone | 303-204-1756
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Fax | 888-611-3669
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Provider Business Mailing Address
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Address Line | 3495 GARLAND ST
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-5825
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Country | US
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Telephone | 303-204-1756
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Fax | 888-611-3669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5075
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License Number State | CO
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