Provider Demographics
NPI:1770019564
Name:ANDERSON, JOLIE ANNE (BS, NLC)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BS, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W JEWELL AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7206
Mailing Address - Country:US
Mailing Address - Phone:720-755-0493
Mailing Address - Fax:
Practice Address - Street 1:5400 W JEWELL AVE STE 1C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80232-7206
Practice Address - Country:US
Practice Address - Phone:720-755-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0106708101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0106708OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES