Provider Demographics
NPI:1952646036
Name:FORNAL, JAIME LYN (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:JAIME
Middle Name:LYN
Last Name:FORNAL
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Gender:F
Credentials:BCBA
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Mailing Address - Street 1:950 N LAFAYETTE ST
Mailing Address - Street 2:# 405
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3162
Mailing Address - Country:US
Mailing Address - Phone:720-470-9239
Mailing Address - Fax:
Practice Address - Street 1:2224 SOUTH FRAISER STREET
Practice Address - Street 2:UNIT 6
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-584-8055
Practice Address - Fax:303-957-2251
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2016-12-15
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Provider Licenses
StateLicense IDTaxonomies
CO1-10-7086103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1182143OtherDENVER OPTIONS INC.