Provider Demographics
NPI:1083100861
Name:JACKSON, ALEXANDRA TATIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TATIANA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3215
Mailing Address - Country:US
Mailing Address - Phone:720-236-7521
Mailing Address - Fax:
Practice Address - Street 1:1332 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-3215
Practice Address - Country:US
Practice Address - Phone:172-023-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health