Provider Demographics
NPI:1679979165
Name:STAPLES, JAMIE L (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11236 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9392
Mailing Address - Country:US
Mailing Address - Phone:970-460-4149
Mailing Address - Fax:
Practice Address - Street 1:11236 HILLCREST DR STE 114
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9392
Practice Address - Country:US
Practice Address - Phone:970-460-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO601202662Medicaid
CO9000202590Medicaid