Provider Demographics
NPI:1972316941
Name:FARLEY, JILLIAN MARIE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 RARITAN ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-6432
Mailing Address - Country:US
Mailing Address - Phone:501-813-5522
Mailing Address - Fax:
Practice Address - Street 1:5290 RARITAN ST UNIT 5
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-6432
Practice Address - Country:US
Practice Address - Phone:501-813-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health