Individual
JEREMY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 YARMOUTH AVE, BOULDER, CO 80304-0564
(303) 786-9314
Mailing address
1501 YARMOUTH AVE, BOULDER, CO 80304-0564
(303) 786-9314
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/02/2016
Last updated
08/02/2016
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