Provider Demographics
NPI:1235399916
Name:ASHLEY, JACQUELYNE S (MA LPC ADTR)
Entity Type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:S
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:MA LPC ADTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80455-0153
Mailing Address - Country:US
Mailing Address - Phone:303-442-6456
Mailing Address - Fax:
Practice Address - Street 1:61 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:CO
Practice Address - Zip Code:80455
Practice Address - Country:US
Practice Address - Phone:720-308-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional