Provider Demographics
NPI:1043380405
Name:ROTHENMAIER, JEANIE HELEN (LPC)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:HELEN
Last Name:ROTHENMAIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 SULKY LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8623
Mailing Address - Country:US
Mailing Address - Phone:303-674-7127
Mailing Address - Fax:303-384-3220
Practice Address - Street 1:607 10TH ST STE 104
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1053
Practice Address - Country:US
Practice Address - Phone:303-562-4906
Practice Address - Fax:303-384-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORO64039OtherANTHEM BLUE CROSS BLUE SHIELD
CO140456OtherCOMPSYCH
CO077349000OtherMAGELLAN BEHAVIORAL HEALTH
CO2068691OtherCIGNA BEHAVIORAL HEALTH