Provider Demographics
NPI:1306186119
Name:PAE, JESSICA YOUNG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:YOUNG
Last Name:PAE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 SOUTHPARK PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5630
Mailing Address - Country:US
Mailing Address - Phone:720-489-8555
Mailing Address - Fax:720-489-8304
Practice Address - Street 1:7921 SOUTHPARK PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5630
Practice Address - Country:US
Practice Address - Phone:720-489-8555
Practice Address - Fax:720-489-8304
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COPSY.0003870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health