Provider Demographics
NPI:1093855090
Name:JACKS, LAURAN (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURAN
Middle Name:
Last Name:JACKS
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9743
Mailing Address - Country:US
Mailing Address - Phone:303-941-1325
Mailing Address - Fax:303-987-0424
Practice Address - Street 1:6438 S QUEBEC ST
Practice Address - Street 2:STE 314
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-7602
Practice Address - Country:US
Practice Address - Phone:303-941-1325
Practice Address - Fax:303-987-0424
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928531041C0700X
CALCSW719321041C0700X
103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$Medicaid
CO503369Medicare Oscar/Certification