Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TC1900X | Counseling Psychologist | ||
Y | 1041C0700X | Clinical Social Worker | 992853 | CO |
N | 1041C0700X | Clinical Social Worker | LCSW71932 | CA |
NPI | 1093855090 |
---|---|
Provider Name | Dr. Lauran Jacks |
First Address | Lone Tree, CO 80124-9743 |
Second Address | Centennial, CO 80111-7602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 20/03/2017 |