Provider Demographics
NPI:1295980753
Name:CUNNINGHAM, JANE (LPC)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 PROMONTORY CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1055
Mailing Address - Country:US
Mailing Address - Phone:303-440-5945
Mailing Address - Fax:
Practice Address - Street 1:3945 PROMONTORY CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1055
Practice Address - Country:US
Practice Address - Phone:303-440-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11707356Medicaid