Provider Demographics
NPI:1053573865
Name:FERRILL, JUDY (RN LPC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FERRILL
Suffix:
Gender:F
Credentials:RN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 JOYCE WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1338
Mailing Address - Country:US
Mailing Address - Phone:303-279-5685
Mailing Address - Fax:303-216-2579
Practice Address - Street 1:1301 ARAPAHOE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1830
Practice Address - Country:US
Practice Address - Phone:303-279-5685
Practice Address - Fax:303-216-2579
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3564101YP2500X
CO50331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13052039Medicaid