Provider Demographics
NPI:1669551776
Name:JACOBY, GEORGENA (PSYD)
Entity type:Individual
Prefix:
First Name:GEORGENA
Middle Name:
Last Name:JACOBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 S ELATI ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4483
Mailing Address - Country:US
Mailing Address - Phone:303-794-7761
Mailing Address - Fax:303-794-7811
Practice Address - Street 1:7800 S ELATI ST
Practice Address - Street 2:SUITE 320
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4483
Practice Address - Country:US
Practice Address - Phone:303-794-7761
Practice Address - Fax:303-794-7811
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
J0146Medicare ID - Type Unspecified