Provider Demographics
NPI:1477847457
Name:JACOBSON, LAYNE RUSSELL (MA, LPC, LAC)
Entity Type:Individual
Prefix:MR
First Name:LAYNE
Middle Name:RUSSELL
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:800-201-5264
Practice Address - Fax:303-432-5071
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO5968101YM0800X
CO0005968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health