Provider Demographics
NPI:1194002048
Name:DAVILA, JAIME RAFAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:RAFAEL
Last Name:DAVILA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 NORTHPARK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3176
Mailing Address - Country:US
Mailing Address - Phone:720-340-2799
Mailing Address - Fax:
Practice Address - Street 1:1526 HAYSTACK WAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9440
Practice Address - Country:US
Practice Address - Phone:303-886-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0012193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional