Healthcare Provider Details

I. General information

NPI: 1093855090
Provider Name (Legal Business Name): LAURAN JACKS LCSW, PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 S QUEBEC ST STE 314
CENTENNIAL CO
80111-7602
US

IV. Provider business mailing address

8618 COLONIAL DR
LONE TREE CO
80124-9743
US

V. Phone/Fax

Practice location:
  • Phone: 303-941-1325
  • Fax: 303-987-0424
Mailing address:
  • Phone: 303-941-1325
  • Fax: 303-987-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992853
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW71932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: