Provider Demographics
NPI:1376010447
Name:ANDERSON, JARL BRENDAN (MA, MFTC)
Entity Type:Individual
Prefix:
First Name:JARL
Middle Name:BRENDAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 W 81ST CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5213
Mailing Address - Country:US
Mailing Address - Phone:303-909-1181
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 219C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6145
Practice Address - Country:US
Practice Address - Phone:720-295-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist