Most Relevant Information
Provider Data
| NPI Number: | 1003369430 |
| Provider Name: | JEREMY ELLIS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/02/2016 |
| Last Updated: | 08/02/2016 |
Provider Practice Location
1501 YARMOUTH AVE
BOULDER
CO
803040564
Practice Location Phone/Fax
| Phone: | 3037869314 |
| Fax: |
Provider Mailing Location
1501 YARMOUTH AVE
BOULDER
CO
803040564
Provider Mailing Phone/Fax
| Phone: | 3037869314 |
| Fax: |