Provider Demographics
NPI:1619003209
Name:JANE SUTLIFF, PH.D., LLC
Entity Type:Organization
Organization Name:JANE SUTLIFF, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-313-3514
Mailing Address - Street 1:357 MCCASLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2941
Mailing Address - Country:US
Mailing Address - Phone:720-313-3514
Mailing Address - Fax:
Practice Address - Street 1:357 MCCASLIN BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2941
Practice Address - Country:US
Practice Address - Phone:720-313-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24833011Medicaid
COC479398Medicare PIN