Provider Demographics
NPI:1740096288
Name:HARRELSON, JOLENE ELIZABETH (MFT)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:ELIZABETH
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 OTIS CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-3138
Mailing Address - Country:US
Mailing Address - Phone:303-319-5096
Mailing Address - Fax:
Practice Address - Street 1:7230 OTIS CT
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-3138
Practice Address - Country:US
Practice Address - Phone:303-319-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14592OtherMFTC