Provider Demographics
NPI:1750402392
Name:LITTLEFIELD, JAY (LPC)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:LITTLEFIELD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-8635
Mailing Address - Country:US
Mailing Address - Phone:970-522-8419
Mailing Address - Fax:
Practice Address - Street 1:17282 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9420
Practice Address - Country:US
Practice Address - Phone:970-522-5775
Practice Address - Fax:970-522-5983
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75655861Medicaid