MEDICARE: DR. JILLIAN DIAMOND PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist	4942	CO

General Provider Information

NPI Number	:	1356748164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILLIAN DIAMOND PSYD

Provider Business Mailing Address
First Line	:	1000 S BROADWAY APT 337
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4167
Country	:	US
Telephone Number	:	413-896-6216
Fax Number	:

Provider Business Practice Location Address
First Line	:	12213 PECOS ST STE 200
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3414
Country	:	US
Telephone Number	:	720-459-7493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	09/09/2019

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