Provider Demographics
NPI:1952641409
Name:SUMIDA, JACQUE KAY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:KAY
Last Name:SUMIDA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 W 14TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4850
Mailing Address - Country:US
Mailing Address - Phone:303-237-1113
Mailing Address - Fax:
Practice Address - Street 1:8745 W 14TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4850
Practice Address - Country:US
Practice Address - Phone:303-237-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional