Provider Demographics
NPI:1174561641
Name:BERGER-JACKSON, LAURIE (PHD CLINICAL PSYCHOL)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:BERGER-JACKSON
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:C
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4498 E PHILLIPS PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:720-312-8691
Mailing Address - Fax:303-694-1907
Practice Address - Street 1:4498 E PHILLIPS PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:720-312-8691
Practice Address - Fax:303-694-1907
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2931103T00000X
CO582AC103TA0400X
CO2653103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling