Provider Demographics
NPI:1558082826
Name:JACQUELINE'S COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:JACQUELINE'S COUNSELING SERVICES LLC
Other - Org Name:JACQUELINE'S COUNSELING SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:970-402-5613
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0251
Mailing Address - Country:US
Mailing Address - Phone:970-402-5613
Mailing Address - Fax:
Practice Address - Street 1:1170 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3523
Practice Address - Country:US
Practice Address - Phone:970-402-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1942655873Medicaid