=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760989552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSIRE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2018
-----------------------------------------------------
Last Update Date | 04/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5808 S RAPP ST STE 235
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-1988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-261-6216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5808 S RAPP ST STE 235
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-1988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-261-6216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSIRE MUNOZ
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 303-261-6216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 12049
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------