Provider Demographics
NPI:1548566409
Name:JOUETT, THERESA LYNN (CCH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:JOUETT
Suffix:
Gender:F
Credentials:CCH
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:JOUETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCH
Mailing Address - Street 1:340 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2438
Mailing Address - Country:US
Mailing Address - Phone:720-620-9255
Mailing Address - Fax:720-863-1957
Practice Address - Street 1:34271 COLUMBINE TRL W
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:CO
Practice Address - Zip Code:80107-7838
Practice Address - Country:US
Practice Address - Phone:720-620-9255
Practice Address - Fax:720-863-1957
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12229102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst