Provider Demographics
NPI:1336466838
Name:JIRON, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JIRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-0211
Mailing Address - Country:US
Mailing Address - Phone:719-588-3459
Mailing Address - Fax:
Practice Address - Street 1:315 STATE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2637
Practice Address - Country:US
Practice Address - Phone:719-588-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5402101YA0400X
CO6541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health