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General NPI Number Information
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NPI Number | 1629796669
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Entity Type | Organization
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Legal Business Name | JENILLE A GUDAHL LPC, LAC, LLC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 800 BELFORD AVE STE 200A
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City | GRAND JCT
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State | CO
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Zip | 81501-3100
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Country | US
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Telephone | 970-361-1038
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Fax |
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Provider Business Mailing Address
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Address Line | 598 SHOSHONE ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-5681
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Country | US
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Telephone | 970-361-1038
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENILLE GUDAHL
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Credential |
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Telephone | 970-361-1038
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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