Provider Demographics
NPI:1992480818
Name:BARCELONA, JESSA T
Entity type:Individual
Prefix:
First Name:JESSA
Middle Name:T
Last Name:BARCELONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSA TATE
Other - Middle Name:CHENOWETH
Other - Last Name:DUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5853
Mailing Address - Country:US
Mailing Address - Phone:925-695-4368
Mailing Address - Fax:
Practice Address - Street 1:1823 SUNSET PL STE C
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6544
Practice Address - Country:US
Practice Address - Phone:720-449-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician