Provider Demographics
NPI:1013085026
Name:ANDERSEN, JAMIE MICHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:BUSQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-0625
Mailing Address - Country:US
Mailing Address - Phone:719-360-0802
Mailing Address - Fax:719-687-4801
Practice Address - Street 1:321 W HENRIETTA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-5045
Practice Address - Country:US
Practice Address - Phone:719-360-0802
Practice Address - Fax:719-687-4801
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532797Medicaid