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General NPI Number Information
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NPI Number | 1548073471
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Entity Type | Individual
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Provider Name | JANELLE MARIE GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 3470 BALTIMORE AVE
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City | PUEBLO
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State | CO
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Zip | 81008-1520
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Country | US
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Telephone | 719-545-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 84 BAYLOR ST
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City | PUEBLO
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State | CO
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Zip | 81005-1640
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Country | US
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Telephone | 713-410-3273
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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