Provider Demographics
NPI:1184284630
Name:JACKMAN, JAMES J (CAC II)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 FOX DR STE 110
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6880
Mailing Address - Country:US
Mailing Address - Phone:720-236-0904
Mailing Address - Fax:
Practice Address - Street 1:8800 FOX DR STE 110
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6880
Practice Address - Country:US
Practice Address - Phone:720-236-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0998191101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)