Provider Demographics
NPI:1538327440
Name:EMMONS, JOHN (M DIV)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:EMMONS
Suffix:
Gender:M
Credentials:M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 MALETA LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7606
Mailing Address - Country:US
Mailing Address - Phone:303-660-2319
Mailing Address - Fax:
Practice Address - Street 1:751 MALETA LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7606
Practice Address - Country:US
Practice Address - Phone:303-660-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional