Provider Demographics
NPI:1124530480
Name:HOLM-DENOMA, JILLIAN (PHD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HOLM-DENOMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E LOUISIANA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1721
Mailing Address - Country:US
Mailing Address - Phone:720-833-1648
Mailing Address - Fax:
Practice Address - Street 1:900 E LOUISIANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1721
Practice Address - Country:US
Practice Address - Phone:720-833-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical