Provider Demographics
NPI:1265613756
Name:JAQUES, MELISSA MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:JAQUES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:JAQUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:380 PERRY ST STE 260
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2487
Mailing Address - Country:US
Mailing Address - Phone:720-282-9827
Mailing Address - Fax:
Practice Address - Street 1:380 PERRY ST STE 260
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2487
Practice Address - Country:US
Practice Address - Phone:720-282-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health