Provider Demographics
NPI:1902381288
Name:PAULEY, JESSIE JAMES (PSYD, LP, CMPC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:JAMES
Last Name:PAULEY
Suffix:
Gender:F
Credentials:PSYD, LP, CMPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 REMINGTON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-7115
Mailing Address - Country:US
Mailing Address - Phone:720-443-2388
Mailing Address - Fax:
Practice Address - Street 1:226 REMINGTON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-7115
Practice Address - Country:US
Practice Address - Phone:720-443-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist