Provider Demographics
NPI:1578008975
Name:POPP, JILLIAN (MS, LPC, LAC, ATR)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:POPP
Suffix:
Gender:F
Credentials:MS, LPC, LAC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4250
Mailing Address - Country:US
Mailing Address - Phone:720-388-5303
Mailing Address - Fax:
Practice Address - Street 1:115 N COLLEGE AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2480
Practice Address - Country:US
Practice Address - Phone:970-430-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000984101YA0400X
COLPC.0014813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1255117065Medicaid