Provider Demographics
NPI:1548413859
Name:JAQUES, CAROL THAYER (MS, LPC, CACIII)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:THAYER
Last Name:JAQUES
Suffix:
Gender:F
Credentials:MS, LPC, CACIII
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:395 E LIONSHEAD CIR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5354
Practice Address - Country:US
Practice Address - Phone:970-476-0930
Practice Address - Fax:970-476-0535
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-6699101YA0400X
CO5758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)