Provider Demographics
NPI:1609008978
Name:IRVINE, JANE ANN (MA, MA CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MA, MA CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 EAST MINERAL PLACE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3016
Mailing Address - Country:US
Mailing Address - Phone:303-478-4600
Mailing Address - Fax:
Practice Address - Street 1:6166 EAST MINERAL PLACE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3016
Practice Address - Country:US
Practice Address - Phone:303-478-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9650101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor