Provider Demographics
NPI:1972049674
Name:TREBELHORN, JAY (BA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:TREBELHORN
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 1:7585 W 66TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-3970
Mailing Address - Country:US
Mailing Address - Phone:303-467-2624
Mailing Address - Fax:
Practice Address - Street 1:7585 W 66TH AVE STE C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-3970
Practice Address - Country:US
Practice Address - Phone:303-467-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1851546832Medicaid