Provider Demographics
NPI:1164159570
Name:TUOHY, JACKIE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:TUOHY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 KAITLYN CIR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8086
Mailing Address - Country:US
Mailing Address - Phone:917-825-3298
Mailing Address - Fax:
Practice Address - Street 1:1438 MORAINE VALLEY DR
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-3281
Practice Address - Country:US
Practice Address - Phone:970-414-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health