Healthcare Provider Details

I. General information

NPI: 1528362209
Provider Name (Legal Business Name): JENNIFER A THORSTAD LPC (COLORADO)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 N LAFAYETTE ST
DENVER CO
80218-1117
US

IV. Provider business mailing address

1754 N LAFAYETTE ST
DENVER CO
80218-1117
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-5534
  • Fax:
Mailing address:
  • Phone: 303-989-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8088
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0013309
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: