Provider Demographics
NPI:1710694773
Name:GURULE, JADE JORDYN
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:JORDYN
Last Name:GURULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 S TEMPE WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-4561
Mailing Address - Country:US
Mailing Address - Phone:626-252-9838
Mailing Address - Fax:
Practice Address - Street 1:2121 S BLACKHAWK ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1488
Practice Address - Country:US
Practice Address - Phone:720-545-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163121902106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician