Individual
JACQUELINE N PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1460 PERRY ST, DENVER, CO 80204-1439
(303) 472-6221
Mailing address
1460 PERRY ST, DENVER, CO 80204-1439
(303) 472-6221
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
94-125-0809
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104702318
CIGNA
CO
Enumeration date
04/16/2019
Last updated
04/16/2019
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