Provider Demographics
NPI:1477018588
Name:JACKSON, ELIZABETH C (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7624 S EMERSON CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3077
Mailing Address - Country:US
Mailing Address - Phone:303-990-0906
Mailing Address - Fax:
Practice Address - Street 1:13300 W 6TH AVE # 22A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1255
Practice Address - Country:US
Practice Address - Phone:303-914-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty