Provider Demographics
NPI:1770339228
Name:STACKPOOL, JESSICA LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:STACKPOOL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7107
Mailing Address - Country:US
Mailing Address - Phone:303-257-8891
Mailing Address - Fax:
Practice Address - Street 1:2900 S SHOSHONE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-1313
Practice Address - Country:US
Practice Address - Phone:303-257-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health