Provider Demographics
NPI:1720630130
Name:JAMES, JENNIFER FULLER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FULLER
Last Name:JAMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-0830
Mailing Address - Country:US
Mailing Address - Phone:719-325-9927
Mailing Address - Fax:719-960-2764
Practice Address - Street 1:400 W MIDLAND AVE STE 100H
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-325-9927
Practice Address - Fax:719-960-2764
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.009918381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical