Provider Demographics
NPI:1790111623
Name:EMERSON, JESSE JAMES (BA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:EMERSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14982 RANDOLPH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-6306
Mailing Address - Country:US
Mailing Address - Phone:303-322-7108
Mailing Address - Fax:
Practice Address - Street 1:4500 CHERRY CREEK DRIVE SOUTH
Practice Address - Street 2:SUITE 940
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1535
Practice Address - Country:US
Practice Address - Phone:303-322-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health