Provider Demographics
NPI:1790448959
Name:MCNALLY, JANISE L
Entity Type:Individual
Prefix:
First Name:JANISE
Middle Name:L
Last Name:MCNALLY
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 1:5327 APPLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8940
Mailing Address - Country:US
Mailing Address - Phone:303-903-4994
Mailing Address - Fax:
Practice Address - Street 1:5327 APPLEBROOK LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-8940
Practice Address - Country:US
Practice Address - Phone:303-903-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17000370103TS0200X
CONLC.0107593102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool