Provider Demographics
NPI:1437796877
Name:PADILLA-GORYL, JESSE THOMAS (BCBA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:PADILLA-GORYL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 NORTH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5797
Mailing Address - Country:US
Mailing Address - Phone:970-200-3838
Mailing Address - Fax:
Practice Address - Street 1:2938 NORTH AVE STE A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5797
Practice Address - Country:US
Practice Address - Phone:970-200-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst