Provider Demographics
NPI: | 1497361646 |
---|---|
Name: | OLGUIN, JESSICA A (LPC) |
Entity Type: | Individual |
Prefix: | |
First Name: | JESSICA |
Middle Name: | A |
Last Name: | OLGUIN |
Suffix: | |
Gender: | F |
Credentials: | LPC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 6901 S PIERCE ST STE 370 |
Mailing Address - Street 2: | |
Mailing Address - City: | LITTLETON |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80128-7202 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 720-515-6385 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6901 S PIERCE ST STE 370 |
Practice Address - Street 2: | |
Practice Address - City: | LITTLETON |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80128-7202 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-515-6385 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2020-09-22 |
Last Update Date: | 2023-03-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | ACD.0000705 | 101YA0400X |
CO | LPC.0014170 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 9000211721 | Medicaid |