Provider Demographics
NPI:1336623305
Name:JENNIFER LUSK LLC
Entity Type:Organization
Organization Name:JENNIFER LUSK LLC
Other - Org Name:LIVING YOUR DANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSK-PUERNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-882-9065
Mailing Address - Street 1:1320 STONEHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2477
Mailing Address - Country:US
Mailing Address - Phone:303-882-9065
Mailing Address - Fax:
Practice Address - Street 1:1320 STONEHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2477
Practice Address - Country:US
Practice Address - Phone:303-882-9065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty