Provider Demographics
NPI:1538106331
Name:GROUBERT, JILL MESTEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MESTEL
Last Name:GROUBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SQUYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8398 FLORA ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5913
Mailing Address - Country:US
Mailing Address - Phone:970-306-6986
Mailing Address - Fax:866-512-0078
Practice Address - Street 1:8398 FLORA ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-5913
Practice Address - Country:US
Practice Address - Phone:970-306-6986
Practice Address - Fax:866-512-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24177103TC0700X
CO3711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048JNOtherBLUE CROSS BLUE SHIELD
TX0048JNOtherBLUE CROSS BLUE SHIELD