Provider Demographics
NPI:1740892199
Name:LIVESAY, JENNA ALEXANDRA (MFTC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ALEXANDRA
Last Name:LIVESAY
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2605
Mailing Address - Country:US
Mailing Address - Phone:540-809-8250
Mailing Address - Fax:
Practice Address - Street 1:789 N SHERMAN ST # 650
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3529
Practice Address - Country:US
Practice Address - Phone:720-295-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist