Provider Demographics
NPI:1215408893
Name:ADAMS, JACQUELYN SHAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:SHAWN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:SHAWN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 882347
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-2347
Mailing Address - Country:US
Mailing Address - Phone:970-846-5207
Mailing Address - Fax:
Practice Address - Street 1:820 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2936
Practice Address - Country:US
Practice Address - Phone:970-846-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099252281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical