Provider Demographics
NPI:1336447630
Name:RUSSELL, JENEVIEVE SUSAN-GLEMMING (MA, LPC, CD)
Entity Type:Individual
Prefix:
First Name:JENEVIEVE
Middle Name:SUSAN-GLEMMING
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, LPC, CD
Other - Prefix:
Other - First Name:JENEVIEVE
Other - Middle Name:SUSAN
Other - Last Name:GLEMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, CD
Mailing Address - Street 1:2800 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3738
Mailing Address - Country:US
Mailing Address - Phone:720-239-2347
Mailing Address - Fax:
Practice Address - Street 1:2800 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3738
Practice Address - Country:US
Practice Address - Phone:720-239-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5384101YP2500X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374J00000XNursing Service Related ProvidersDoula