Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1052143 | CO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1104000223 |
---|---|
Provider Name | Juliet Conners Blevins |
First Address | Louisville, CO 80027-5035 |
Second Address | Lafayette, CO 80026-2833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 01/03/2019 |