Provider Demographics
NPI:1467704205
Name:GRUENHAGEN, JEANETTE KM (LPC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:KM
Last Name:GRUENHAGEN
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 1:3495 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5825
Mailing Address - Country:US
Mailing Address - Phone:303-204-1756
Mailing Address - Fax:888-611-3669
Practice Address - Street 1:720 KIPLING ST STE 113
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5866
Practice Address - Country:US
Practice Address - Phone:303-204-1756
Practice Address - Fax:888-611-3669
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health